Nurisng DX Noncompliance

[jsta_grl83]

Hi, I have to write some nursing dx for a patient that I interviewed at her home. At one point she stated that she sometimes throws the pills her daughter gives her down the garbage disposal because she doesnt want to take them. She takes a dieurtic that she said makes her pee too much and another pill that she doesnt like. I was wondering if Noncompliance is an appropriate diagnosis, and if so what would it be r/t?? I have my nursing handbook here but I can't seem to find an appropriate r/t. Thanks!

[traumaRUs, MSN, APRN]

r/t patient stating "sometimes I throw my pills down the garbage disposal" as evidenced by three plus pedal edema from disposing of diuretic and blood pressure of 210/150 from disposing of anti-hypertensive.

Hope that helps.

[Daytonite, BSN, RN]

NANDA lists several categories of etiologies for the related factors for this particular diagnosis. I would think that since your symptom, or defining characteristic, to use this diagnosis is that the patient states that she throws her pills down the garbage disposal because she doesn't want to take them, then the "individual" etiologies listed for this diagnosis would apply. They are:

• cultural influences
  
• developmental abilities
  
• health beliefs
  
• individual's value system
  
• knowledge relevant to the regimen behavior
  
• motivational forces
  
• personal abilities
  
• significant others
  
• skill relevant to the regimen behavior
  
• spiritual values
  
• (page 146-7, NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008 published by NANDA International)

It seems to me that the one that applies here would be "individual's value system". The excuse of just not wanting to take her pills is related to one's values. Obviously, she isn't thinking of the results of her actions, is she? So, an appropriate 3-part diagnosis for her would be Noncompliance R/T personal values AEB patient statement that she throws her pills down the garbage disposal because she doesn't want to take them. If you can show that the patient isn't aware of the consequences of her actions in throwing her pills away and not taking them, then "knowledge relevant to the regimen behavior" would be appropriate to use as the related factor. Your symptoms (AEB items) must describe the problem. In this case, the definition of this diagnosis is "behavior of person and/or caregiver that fails to coincide with a health-promoting or therapeutic plan agreed on by the person (and or family and/or community) and health care professional. In the presence of an agreed-on, health-promoting or therapeutic plan, person's or caregiver's behavior is fully or partially nonadherent and may lead to clinically ineffective or partially ineffective outcomes." So, the focus of the symptoms of this diagnosis is the behavior the patient displays. Certainly, the behavior of throwing one's pills away is a failure to coincide with the therapeutic plan, wouldn't you say?

[leslie :-D]

does you pt truly know what will happen to her, if she doesn't take her meds?

does she know the risks of edema and htn?

if not, i would use knowledge deficit.

if she is fully aware of risks involved, then:

-ineffective mgmt of therapeutic regimen r/t noncompliance (meds) aeb pt statement of"...", edema, elevated bp

-ineffective health maintenance r/t noncompliance (meds) aeb pt statement of "...", edema, elevated bp

-risk for trauma/injury r/t noncompliance (meds) aeb pt statement of "...," edema, elevated bp.

and yes, you could use noncompliance, but you really need to know why she's being noncompliant.

whereas with the other nsg dxs, they can all be r/t noncompliance while acknowledging the implications of ea dx.

if it were me, unless i knew why she was being noncompliant, i wouldn't have a r/t factor.

leslie