i need a nursing dx for non-compliance

SopranoKris, MSN, RN, NP · May 10, 2014

No, it's not. You're trying to make a diagnosis "fit". What is your patient currently displaying now that he's back in the hospital? What is he at risk for? Think about it...

Episteme · May 10, 2014

So, you're in Domain 1, (Health Promotion) Class 2 (Health Management). I think the best defining characteristic is "Inability to take responsibility for meeting basic health practices" and your Related Factor would be "Insufficient resources (e.g., equipment, finances)".

There are better people on here than I am, more comfortable with NANDA-I. But this is what I'm seeing on p. 157 in "the book".

To SopranoKris' point... You say your patient has a ruptured divertic. Should you be thinking about "higher order needs" when you've given no assessment data on the pt's physiological well-being? I mean, if he was admitted with peritoneal signs, or ileus, signs of sepsis... wouldn't that take precedence?

jbeazer703 · May 10, 2014

Thanks for much for your guidance. I changed my actual diagnosis to

Altered Comfort: Acute Pain related to micro-perforation of diverticulum and out pouching colon as evidenced by patient positioning to minimize pain, restlessness, sighing, diaphoretic , elevated bloodp pressure, heart rate and respiratory rate, reports pain of 9 out of 10

I have to prepare a wellness and a risk diagnosis as well. I am also struggling because I let someone borrow my textbook and they never returned it. Above you reference p. 157. Can you tell me what book you are using so that I can order it?

Again, many thanks for your heln.

SopranoKris, MSN, RN, NP · May 10, 2014

Above you reference p. 157. Can you tell me what book you are using so that I can order it?
Again, many thanks for your heln.

She's referencing the NANDA-I book. If you don't have it...GET IT!!!! Worth every penny! :)

Esme12, ASN, BSN, RN · May 10, 2014

Thanks for much for your guidance. I changed my actual diagnosis to
Altered Comfort: Acute Pain related to micro-perforation of diverticulum and out pouching colon as evidenced by patient positioning to minimize pain, restlessness, sighing, diaphoretic , elevated bloodp pressure, heart rate and respiratory rate, reports pain of 9 out of 10
I have to prepare a wellness and a risk diagnosis as well. I am also struggling because I let someone borrow my textbook and they never returned it. Above you reference p. 157. Can you tell me what book you are using so that I can order it?
Again, many thanks for your heln.

Don't loan your textbooks until you are done with your work They can visit you and use it but don't let is leave your sight.

What semester are you?

Care plans are ALL about the patient assessment...what they need NOW! Tell me about your patient

jbeazer703 · May 11, 2014

I have just begun block 2 out of 4. My patient is 19. He has diverticulitis. He was treated and discharged. He came back 72 hours later with diverticulitis with a microperforation of diverticulum due to non-compliance. (he couldn't afford to eat properly or purchase the flagyl). He is in pain but not throwing up. He has loose stools. Afebrile. I have to come up with three diagnosis - one actual, one risk, and one wellness. Listed below is what I came up with. I'll take any advice I can get. By the way, you are right about loaning books that was a huge mistake. She is not picking up the phone and I have no book. I had a nurse's pocket guide published by Davis but it seems worthless.

Actual DX -

Altered Comfort: Acute Pain related to micro perforation of diverticulum and out pouching colon as evidenced by patient positioning to minimize pain, restlessness, sighing, diaphoretic , elevated heart and respiratory rate and reports pain of 9 out of 10.

Risk - Risk for deficient fluid volume related to inflammation

Wellness DX -

Readiness for enhanced self-health management related to dietary choices as evidenced by patient stating, “I am really ready to eat right. Can I get a list of foods I can eat and those I can’t”

JustBeachyNurse, LPN · May 11, 2014

You need the nanda-I 2012-2014 book to properly create a nursing diagnosis statement to list accepted r/t and risk factors for the nursing diagnosis. It's relatively cheap and available as an Ebook for nook and kindle also.

nurseprnRN, BSN, RN · May 16, 2014

I have just begun block 2 out of 4. My patient is 19. He has diverticulitis. He was treated and discharged. He came back 72 hours later with diverticulitis with a microperforation of diverticulum due to non-compliance. (he couldn't afford to eat properly or purchase the flagyl). He is in pain but not throwing up. He has loose stools. Afebrile. I have to come up with three diagnosis - one actual, one risk, and one wellness. Listed below is what I came up with. I'll take any advice I can get. By the way, you are right about loaning books that was a huge mistake. She is not picking up the phone and I have no book. I had a nurse's pocket guide published by Davis but it seems worthless.
Actual DX -
Altered Comfort: Acute Pain related to micro perforation of diverticulum and out pouching colon as evidenced by patient positioning to minimize pain, restlessness, sighing, diaphoretic , elevated heart and respiratory rate and reports pain of 9 out of 10.
Risk - Risk for deficient fluid volume related to inflammation
Wellness DX -
Readiness for enhanced self-health management related to dietary choices as evidenced by patient stating, “I am really ready to eat right. Can I get a list of foods I can eat and those I can’t”

There is no such thing as a "nursing diagnosis for noncompliance." We also don't call it "noncompliance" On what anymore, and haven't for years. Compliance has to do with following someone's order. Patients always have control over what recommendations or prescriptions they choose to follow. This concept is called adherence, and you would be well to use that word in future.

There is no such risk factor for risk of deficient fluid volume (page 188 in your NANDA-I 2012-2014, available for $29 at Amazon or $25 for your iPad or Kindle). This diagnosis is defined as, "At risk for experiencing decreased intravascular, interstitial, and/or intracellular fluid. This refers to risk for dehydration, water loss alone without change in serum sodium."

Risk diagnoses do not have related to/causative factors. They have risk factors. This one lists 12 that are approved, but not one is inflammation.

The nursing diagnosis, "Readiness for enhanced self health management (p. 164)," is defined as: "A pattern of regulating in integrating into daily living a therapeutic regimen for the treatment of illness and its sequelae that is sufficient for meeting health-related goals and can be strengthened." Readiness diagnoses also do not have related factors, they have defining characteristics only. These are your "as evidenced by" components. They are the evidence by which you make your nursing diagnosis.

You have to remember that the term "related to" does not mean "has some general relationship to," or, "has something to do with, sorta kind of," it means "caused by." Clearly this person is not ready for enhanced self health management because he has dietary choices. So, let's look at the defining characteristics for this diagnosis.

Defining characteristics for this diagnosis include:

* choices of daily living are appropriate for meeting goals (e.g., treatment, prevention)

* describes reduction of risk factors

* expresses desire to manage the illness (e.g., treatment, prevention of sequelae)

* expresses little difficulty with prescribed regimens

* no unexpected acceleration of illness symptoms

Try to remember that you are learning to make nursing diagnoses, not choose them off the list. Just as there are criteria for making, say, a medical diagnosis of anemia, so there are also specific criteria for making nursing diagnoses. You have to get the book. "Care plan handbooks" do not have all this information in them, because NANDA-I does not give anyone else permission to quote their entire work. Also, many handbooks are working off old versions of NANDA-I, and may include nursing diagnoses which have been removed from the work because they have no evidence-based support. Get the book.

That's it. Try again, and see what you come up with.

acedit · May 16, 2014

GrnTea, you're such an awesome teacher. I have an awesome care plan book but now I see that I did myself a disservice by not getting the NANDA-I.

Guest 360983 · May 24, 2014

I know this is probably late but for future students: So tell us more about your patient. I see he is diaphoretic, tachycardic and tachypenic. What did your abdominal assessment reveal? What did the rest of your skin assessment show? What were his lab results, especially his lactate? What did imaging show beyond the microperf? What is his plan of care? What do his stools look like beyond loose? What are his comorbidities? What are his vitals?

Psin sucks but will not kill the patient the way sepsis can.