Nsg Diagnosis in CPNE study guide

BBFRN, BSN, PhD · Jun 3, 2008

That should be one of the questions you ask the pt's nurse when you get report from her, if you plan on using that as a nsg dx. You will be starting your care plan before you see the patient, but you are allowed to change it after you're done with the PCS, if you used something that wasn't pertinent.

A good tip for your care plan during the CPNE: go by what your areas of care will be, or what the pt is in the hospital for. Also, if the patient has been there for

SuesquatchRN, BSN, RN · Jun 4, 2008

I used "aeb pain of _ on 0 - 10 scale." "Will report pain of

Daytonite, BSN, RN · Jun 4, 2008

i would recommend that you look at the defining characteristics that nanda lists for acute pain. i honestly don't know how in the world you can be expected to list any defining characteristics (symptoms) for a specific diagnosis prior to attending clinicals when you haven't even seen the patient yet unless you have access to the person's medical record! if you don't have a nanda reference, this weblink has the information on it: [color=#3366ff]acute pain. otherwise, i would say your study guide saying that acute pain is manifested as 7 out of 10 is just being used as an example of an assessment of a patient's verbal report of pain ranking it on a scale, but pain can also be assessed and reported as behavioral, sympathetic and parasympathetic responses by patients (many of these are listed as defining characteristics by nanda). your study guide could very easily have also said "acute pain r/t tissue trauma aeb crying, facial grimacing, and patient moaning that "my belly hurts!"

another tip: absolutely do not use "risk for infection," if the patient is getting abts.

"risk for" diagnoses are potential problems that do not yet exist. if a patient has been diagnosed by the doctor with an infection already it would be inappropriate to say they are at risk for an infection! however, there are circumstances where patients are placed on antibiotics as a prophylactic measure by physicians as their treatment to prevent infection from occurring. i would have no problem using a

risk for infection

nursing diagnosis if my assessment determined that an infection was a possible complication that the patient was in jeopardy of getting, antibiotics on board or not. example: post op patients get antibiotics prophylactically all the time in the or and recovery room area but are still at risk for infection that those antibiotics won't work against.

BBFRN, BSN, PhD · Jun 4, 2008

Daytonite- they do have access to the pt's medical records prior to seeing the patient.

DoubleblessedRN, ADN, RN, EMT-B, EMT-P · Jun 6, 2008

one thing that i just cannot wrap my head around is, when you say acute pain r/t tissue trauma aeb 7 out of 10 pain.... is that you write these up before you go into the room right?

during the planning phase, only the diagnostic label is being scored. the related to and as evidenced by need not be included at that time because you have not seen the patient yet, but it must be included during the evaluation phase. the care plan can be revised any time during the implementation phase if the student finds a more suitable or appropraite dx.

DoubleblessedRN, ADN, RN, EMT-B, EMT-P · Jun 6, 2008

I am going through the study guide doing all the practice questions and sample PCS things they have in there and all its doing is making me feel stupid. I think I may be lost on this nursing diagnosis stuff. I always end up thinking of a different one and not the one excelsior thinks is the best... or whatever. Anyway, I am just really frustrated and needed to get it out before I freak out.
:)

Look in Carpenito's or Mosby's dx book and tab the pages for:

Ineffective Airway Clearance

Activity Intolerance

Impaired Physical Mobility

Impaired Bed Mobility

Acute Pain

Impaired Comfort

Ineffective Coping

Risk for Injury

Most of these dx's would fit almost any pt. Then highlight some measurable goals and interventions within the alloted time. Highlighting is allowed, but no writing other than your name.

Try to use a dx in collaboration with Assigned Areas of Care. For example, if assigned Respiratory Management with deep breathing and coughing:

Dx: Ineffective Airway Clearance

Goal: pt will demonstrate effective cough

Intervention 1: Assess lung sounds

Intervention 2: Instruct pt to take 3-4 deep breaths, then cough forcefully.

The interventions are already some of the critical elements of Resp Mgmt, therefore, you are not making extra work for yourself. Time is not on your side! See, that wasn't hard!

ivanh3 · Jun 6, 2008

I am an EC grad and what I did was work backwards: When you are looking at your kardex/assignments and are setting up your grid, look at the actual task you will be doing. Pick a few of the key task and ask yourself, "Why am I doing this?" Example:

Let's say two tasks assigned during your PCS are pain management and pain medication for a post op patient. Why? To reduce pain. So it is likely that patient (who you haven't seen yet) is in pain, right? So here goes:

What are some of your responsibilities under pain management? Back rub, reposition, distraction, etc. You also have orders to give a pain med. So pick two of the individual task first. In this case I would pick pain med, and reposition. I am not going to give a back rub because of time. Medicate and reposition: both take little time (just be careful about all the steps associated with giving a med). Now work backwards to get to your diagnosis: Pain med/reposition (two interventions I will be doing based on my kardex, now two of my interventions for my nursing dx). Why? For Pain (my nursing dx!). So the reverse is:

Nx diagnosis: Pain. Patient will have a decrease in pain. My two interventions are 1) give pain med 2) reposition patient

Now, unless things have changed, you don't have to add the "related to" (r/t) or "as evidensed by" (AEB) until the evaluation/charting phase. So don't add them now, like you said, you haven't seen your patient yet.

You then go in the room and during the PCS you give a pain med and repostion. Check these off on your grid.

When you get to the evaluation phase, you will do several things:

1) Add the r/t and AEB. Now it will look like this:

Nx diagnosis: Pain r/t surgery. Patient will have a decrease in pain AEB patient report of a decrease in pain using the numeric scale. My two interventions are 1) give pain med 2) reposition patient

You then have to document if your measures worked or not. If they didn't don't sweat it. Just make sure you document it.

The key is too make sure your interventions that you have for your nursing dx are items already assigned to you on your kardex. Do NOT add tasks that are not assigned. It will add more work and could cause you to fail the PCS.

Hope this helps.

Ivan

Ps, I also have a guide I wrote. It is in PDF form. It can be found here.

changeofpaceRN · Jun 7, 2008

Thanks for the help!

Ronnie22 · Jun 8, 2008

I'm not sure about the rest of you guys, but the "Nursing Diagnosis" is what has confused me throughout my EC studies.

Pounding into my head a nursing diagnosis is not a real diagnosis. :banghead: It is not a true diagnosis, but is constantly called diagnosis.. very confusing for me to get my brain around.

Melinurse · Jun 8, 2008

You made it this far so you must be doing something right. Focus on patients priority of needs, airway, breathing, circulation, Maslow's,etc. Then based on your Kardex and above priorities go with your gut feeling. Remember, you are the nurse and you will base your care for the patient on your nursing diagnosis. Just because EC Study Guide has something different does not mean your diagnosis is wrong either. Have someone at work look at your care plans if possible or post a few on this forum. We are all in the same boat here. I remember feeling like:banghead: as I was studying the CPNE guide too. Focus on your patient and you'll do fine. :up:

SuesquatchRN, BSN, RN · Jun 8, 2008

Heads up - Carpeniti's has nsg diag that Mosby's does not. Make sure the one you're using has the one you pick - impaired comfort, alteration in comfort - not in Mosby's.

And get the Mosby's if you haven't bought one yet. They'll be eliminating Carpenito's.

FocusRN · Jun 9, 2008

thank you very much, that does help. :-)
one thing that i just cannot wrap my head around is, when you say acute pain r/t tissue trauma aeb 7 out of 10 pain.... is that you write these up before you go into the room right? well how do you know if their pain is a 7? do you see it when you get the kardex and the other information from report and you can change it during the eval phase if it is now a 2? ive been doing the ones in the study guide and one is like the above nsg dx and i just didnt know how they got that number... and i guess thats what actually got me all confused about this in the first place.... :chuckle.... oh my my my. i think ill get it eventually. :-)

remember that in the planning phase (before you go in the room), you only need to have the diagnostic statement part of the ndx. so for the above ndx when you go in the room you will only need to have "acute pain", no r/t or aeb. for a diagnostic statement like pain there is no way you can have the aeb before you go into the room (maybe the r/t will be obvious from the kardex, but not the aeb, since you have to get the pt to verbalize to you what their level of pain is). you'll just have to fill that in later.

with other diagnostic statements, you can complete the entire ndx from the kardex alone. like, "risk for infection r/t presence of invasive lines" if they have an iv (that you know from the kardex). and remember that a risk ndx, only has two parts, unlike an actual with three.

another example where you may be able to complete the entire ndx before entering the room, would be something like "impaired physical mobility r/t genralized weakness aeb needing one assist to ambulate to bathroom".

remember, that your ndx is in the kardex. for your actual ndx, look at the areas of care that you are assigned to, find your problem, and your interventions will most likely be things that you have to do anyway.

keep it simple. i know when doing the practice pcs, things in the guide, you look at the answer page, and feel like "damn, am i stupid?" like you're just not getting it, but all you have to do is pick two ndx's that apply to the pcs, they do not have to be what ec considers, the best or most relevant, they just have to make sense for that pcs, with the given info on the kardex. so, they can be as simple, as pie, as long as they apply.

i recommend the following, to try to keep confusion down:

pick both ndx from, your assigned areas of care on the kardex.
the, reasoning for you actual, priority ndx, should always be "if not managed now will deter progress to achieve outcomes, or will negatively affect the patients functional status.
use acute pain, as a priority diagnosis, whenever possible.
use risk for infection r/t presence of invasive lines, as a secondary, ndx, for any pt with a current iv. your interventions will be 1. meticulous hand washing, 2. strict aseptic technique. and, your, goal will be "the pt will: remain free from infection during pcs". the above interventions, are required of you during every pcs anyway.

you can try to get crazy and creative with you ndx if you want, but i know i won't, we have too much to worry about, other than that.