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Discussion

Nursing Care Plan Suggestions

Hi, I'm new to posting, so please forgive me. I'm looking for any sugggestions or advice. I'm currently working on my careplan for my 68 yo patient. She was admitted with cellulitis & dry gangrene on her 3rd toe of her right foot due to an acute injury 2 1/2 weeks ago. She is diabetic, overweight, smokes and has PVD, hypertension, hyperlipidemia & Hx of an MI.

My nursing diagnoses so far are as follows:

Ineffective Tissue Perfusion - peripheral r/t impaired transport of oxygen 2nd/t Diabetes Mellitus & PVD AEB absent R post-tibial pulse & dry gangrene on 3rd toe on R foot.

Imbalanced Nutrition – More than body requirements r/t poor eating habits AEB client is overweight, has hyperlipidemia & admits to noncompliance with diabetic meal plan.

Disturbed Body Image r/t change in foot appearance AEB 3rd toe on R foot is black & patient was informed that it will fall off.

Risk for Infection r/t decreased sensation & circulation in lower extremities 2nd to DM & PVD.

Any suggestions to tweak these diagnoses or other diagnoses to think about would be greatly appreciated. :bow:

Featured Replies

  • Expert

in order of priority:

ineffective tissue perfusion - peripheral r/t impaired transport of oxygen 2nd/t diabetes mellitus, pvd and effects of smoking aeb absent r post-tibial pulse & dry gangrene on 3rd toe on r foot.

related factor: is impaired transport of oxygen really what is going on? with
pvd
it is "obstructed blood flow" especially since there is no pulse.

evidence: "dry gangrene" is a medical diagnosis and shouldn't be used as a symptom. you need to find another factual way to describe the appearance of this toe.

better: ineffective tissue perfusion, peripheral r/t obstructed blood flow due to pvd aeb [description of wound on 3rd toe r foot] and absent r posterior tibial pulse.

imbalanced nutrition - more than body requirements r/t poor eating habits aeb client is overweight, has hyperlipidemia & admits to noncompliance with diabetic meal plan.

related factor: a person eats more because they eat more than their body needs

evidence: "noncompliance with diabetic meal plan" is a defining characteristic for a different nursing diagnosis

better: imbalanced nutrition: more than body requirements r/t food intake greater than metabolic need aeb overweight for height and frame and hyperlipidemia [should report the lab result].

ineffective health maintenance r/t history of lack of health-seeking behaviors aeb poor eating habits and failure to follow diabetic meal plan

disturbed body image r/t change in foot appearance aeb 3rd toe on r foot is black & patient was informed that it will fall off.

related factor: the altered appearance of the foot; the loss of a body part

evidence: "patient was informed that it will fall off" is not a clear statement of evidence and sounds like charting of an intervention that was done. this diagnosis is a psychosocial one and involves the patient's
behavior
or their reference to their feelings about their physical appearance, so that is what your symptoms should be about.

better: disturbed body image r/t permanently altered appearance of the foot aeb verbalized expressions of upset over eventual loss of 3rd toe r foot as a result of trauma.

risk for infection r/t decreased sensation & circulation in lower extremities 2nd to dm & pvd.

risk factor: why is a diabetic at risk for infections? because they tend to have high blood sugars which impairs healing--especially this lady who is obese and you have already said doesn't follow her diabetic meal plan. i had a stasis ulcer in the middle of my leg for a year that wasn't healing. they finally discovered i had blood sugars over 130--i was a type ii diabetic! when they got the blood glucose controlled the boo boo healed up pretty fast. decreased sensation is a risk for injury--that's how i got my boo boo in the first place.

better: risk for infection r/t hyperglycemia and decreased circulation secondary to diabetes mellitus and pvd

  • Author

Hi Daytonite,

I just want to thank you for sharing your invaluable experience & insight. You've really helped me better understand writing proper nursing diagnoses. I'm sure I'll be looking forward to your feedback & suggestions in the future.

By the way, in regards to: "evidence: "patient was informed that it will fall off" is not a clear statement of evidence and sounds like charting of an intervention that was done." I was actually in the pt's room with the physician when he relayed that info to the pt.

So glad your boo-boo healed! :yeah:

Thanks again for your help, JoDee

  • Expert
So glad your boo-boo healed! :yeah:

Me, too.

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