Nursing Care Plan-self care deficit or risk for falls?

[brawhe]

I am in need of help. I just started the program and I am having problems with developing nursing care plans. I have a pt that has severe Parkinson's, dementia, depression, psychosis(hallucinations). The pt is unable to bath herself, feed, dress, walk without assistance. Would my primary diagnosis be a self care deficit or risk for falls.? Her tremors are severe, some days she is unable to talk. She tries to feed herself but the food does not make it to her mouth most of the time due to the tremors. I want to go with self care deficit....am I on the right track???

[Forever Sunshine, ASN, RN]

Yes you are

Risk for falls related to unsteady gait

Self-care deficit related to ..and then you'd put pathophysiology of parkinsons since you can't put a medical dx after related to. and an as evidenced by from your assessment

[Angel@MyTable, RN]

My instructors always tell us to focus on ABC's (airway, breathing and circulation)first. Your pt. sounds like she would be a good at risk for imbalanced nutrition; less than body requirement r/t or risk for injury/falls r/t. I would say to focus on what you feel her priority Dx should be.

[stillinschool2010]

We are told that almost all of the time an "actual" diagnosis takes precedence over a "risk for" however there are always exceptions.

[Bug Out, BSN]

Safety first!

Who cares about how many jelly donuts she is going to eat for lunch when she is at a high risk of falling...falling=broken hip=death=bad day for all those involved.

Think of your priorities...

Yes ADLs and nutrition are important but patient safety is ALWAYS #1

[Daytonite, BSN, RN]

you are on the right track and need a little help here. care planning is about determining the patient's nursing problems and then doing something about them. to do that we use the nursing process which is our problem solving method and tool. first we assess to find out what is not normal and you gave this information:

• medical conditions:
  
  • severe parkinson's
    
  • dementia
    
  • depression
    
  • psychosis(hallucinations)
    

  [*]nursing assessment:

  • walk without assistance
    
  • severe tremors
    
  • tries to feed herself but the food does not make it to her mouth most of the time due to the tremors
    
  • unable to bath herself, feed, dress
    
  • some days she is unable to talk
    

next, from that information we are able to make our nursing judgment as to what the nursing problems are and name them (nursing diagnoses). i always encourage students to look up the medical disease/conditions (their pathophysiology, signs and symptoms and complications) as well as any medications (including side effects) the patient is getting because they sometimes yield more information or clues you might have missed seeing in the patient. and, you always want to be thinking about potential problems based on the patient's history.

prioritizing of the diagnoses is generally done by maslow's hierarchy of needs based on the symptoms (nursing assessment data used to determine the diagnosis), not as bug out said "who cares about how many jelly donuts she is going to eat for lunch when she is at a high risk of falling...falling=broken hip=death=bad day for all those involved." i hope they were being facetious because the comment indicates a disregard for the nursing process as well as priority of care.

• impaired walking
  
• feeding self-care deficit
  
• bathing self-care deficit
  
• dressing self-care deficit
  
• impaired verbal communication
  
• risk for falls or risk for injury
  

these are the current diagnoses approved and listed in the 2009-2011 nanda taxonomy. you should also consider chronic confusion if the symptoms are there.