Nursing Care Plan Suggestions

[jbw1017]

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.

[Daytonite, BSN, RN]

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

[jbw1017]

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!

Thanks again for your help, JoDee

[Daytonite, BSN, RN]

So glad your boo-boo healed!

Me, too.