10 nursing diagnoses. Stuck.

nurseprnRN, BSN, RN · Feb 16, 2012

i'm thinking something about caregiver role strain at home-- who doesn't notice her six-year-old is that filthy? somebody who has too much on her plate, is my guess.

ashleyv89 · Feb 16, 2012

Thanks, I did have caregiver role strain down as one of the diagnoses I came up with. I feel like I'm overlooking something - everyone keeps telling me how they can easily come up with 15-20 diagnoses for their clients! I had a list of things that I thought might fit, but I find that there are a lot of diagnoses that are pretty much the same thing so don't want to state the same problem twice.

Esme12, ASN, BSN, RN · Feb 16, 2012

ok....first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms. let me try to help you. there are many nurses here and many who came before me to this site but one nurse stands out.....daytonite(rip) https://allnurses.com/general-nursing...ns-286986.html you can also use the search on this site to lead you to care plans. i have supplied links of examples at the bottom for care plan. think maslow's hierarchy of needs. maslow's hierarchy of needs - enotes.com virginia henderson's need theory

maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization – e.g. morality, creativity, problem solving.
esteem – e.g. confidence, self-esteem, achievement, respect.
belongingness – e.g. love, friendship, intimacy, family.
safety – e.g. security of environment, employment, resources, health, property.
physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

maslow’s theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. abraham lincoln, thomas jefferson, albert einstein, eleanor roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.

every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the nanda taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what nanda calls defining characteristics.

here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

now, listen up, because what i am telling you next is very important information and is probably going to change your whole attitude about care plans and the nursing process. . .

a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its rns to learn by graduation is how to use the nursing process to solve patient problems.

care plan reality: the foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. what is happening to them could be a medical disease, a physical condition, a failure to be able to perform adls (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. therefore, one of your primary aims as a problem solver is to collect as much data as you can get your hands on. the more the better. you have to be a detective and always be on the alert and lookout for clues. at all times. and that is within the spirit of step #1 of this whole nursing process.

assessment is an important skill. it will take you a long time to become proficient in assessing patients. assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. history can reveal import clues. it takes time and experience to know what questions to ask to elicit good answers. part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. but, there will be times that this won't be known. just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

a nursing diagnosis standing by itself means nothing. the meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient. in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are.

what i would suggest you do is to work the nursing process from step #1. take a look at the information you collected on the patient during your physical assessment and review of their medical record. start making a list of abnormal data which will now become a list of their symptoms. don't forget to include an assessment of their ability to perform adls (because that's what we nurses shine at). the adls are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. what is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. this is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

one more thing . . . care plan reality: nursing diagnoses, nursing interventions and goals are all based upon the patient's symptoms, or defining characteristics. they are all linked together with each other to form a nice related circle of cause and effect.

you really shouldn't focus too much time on the nursing diagnoses. most of your focus should really be on gathering together the symptoms the patient has because the entire care plan is based upon them. the nursing diagnosis is only one small part of the care plan and to focus so much time and energy on it takes away from the remainder of the work that needs to be done on the care plan.

nursing diagnoses: reason patient required care of nurse.

1. nanda statement: most instructors look for actual (rather than 'risk for') when patient is in the hospital

2. related to: related to usually medical diagnosis or major signs/symptoms

3. as evidenced by: assess or evaluate data which supports nursing diagnosis

patient outcomes: measurable outcome criteria.

uses ranges: ____ to ____, greater than or equal to, scale, parameters
time frame: acute (minutes, hours, days); long term (weeks, months, years)

1. vital signs - oximetry, cardiac monitor values, icp, etc.

2. body systems assessments

3. pain

4. nutrition/fluids

5. meds

6. labs/diagnostics ranges

7. teaching learning/psychosocial

8. adl's

9. other/wellness items

planning: broad goals. think of kardex. plan for oncoming shift.

goal statement = opposite from nursing statement
never past tense - to do in the future
monitor, assess, perform, check, obtain, teach, follow protocols/guidelines

implementation:

actual interventions. usually past tense
what care was provided for patient?
how did you gather data to measure against your normal ranges in your outcome criteria?
frequency - how often did you obtain patient data?

evaluation:

each goal met/not met: should read like you actually documented vital signs, assess, care on your patient
which labs/dx did you check?
what was taught/what support measures, comfort used?

https://allnurses.com/general-nursing-student/care-plan-template-84543.html

don't forget the child's milestones. a nursing diagnosis is a nursing problem that is based upon data that was collected during assessment activities. a 5-year old is in the process of growth and development. a school age child on erickson's developmental stages is entering the industry vs inferiority stage where they work to develop a sense of self-worth (self-esteem). this would have been seen by their behavior in how they answered questions or behaved. recall your conversation with this child again and their behavior that you observed. read about erickson's developmental stages. the child may still be in the preschooler stage of initiative vs guilt where they initiate activities and develop a conscience (you will see them enforcing rules on others). you can go to any of the pediatrics websites listed on this thread (https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html) and look for developmental milestones for a 5-year old child to see if this patient is meeting them. there are two nursing diagnoses pertaining to child growth: delayed growth and development and risk for disproportionate growth and development. delayed growth and development is seen in children who have had serious illness at a very early age. their social and verbal skills are not up to par. sometimes their physical growth is lagging behind. if the child is struggling with self-esteem there are self esteem diagnoses. you can always create a wellness diagnosis that begins with the wording "readiness for enhanced" growth and development and give interventions that would be appropriate to encouraging the normal development of a 5 year old. you would find them on the websites listed above. the goals for readiness diagnoses are always to improve the subject being addressed (in this case, growth and development). https://allnurses.com/general-nursing-student/peds-nursing-diagnosis-377615.html
care of the patient following a traumatic injury this is an example fora trauma care plan that you will have to adapt for a child.

ashleyv89 · Feb 16, 2012

Thank you very much for your lengthy reply. I am a third semester nursing student, so a lot of the information is stuff I've already learned but great to be refreshed on it! I usually don't put so much emphasis on trying to "come up with" a bunch of diagnoses and I focus my care on what the immediate problems are with my patients, but for this graded care plan we MUST have a minimum of 10 diagnoses to get full credit. I was able to brainstorm last night and came up with what I needed. I know how to do a care plan, I was just having a brain-dead moment staring at my NANDA diagnosis list and book and not being able to connect any dots. I will be visiting the links you sent. The trauma care plan looks like a great learning instrument. Thanks for the help!

Esme12, ASN, BSN, RN · Feb 16, 2012

You just never know where someone is.....Ok I was wondering why the little guy was so hypothermic, with the hematoma anemia will be a big deal. How long will he be NPO? Why was the little guy not cleaned up after being in the hospital for a couple of days? Is Mom in need of some teaching? Are living conditions ok at home? We allhave braindeadmoments. Good Luck in school!

ashleyv89 · Feb 16, 2012

97.9 axillary temp isn't hypothermic, axillary temps can usually be about 1 degree lower than oral. he will be NPO until resolution of the hematoma which could potentially take weeks. He was scheduled to start TPN either that night or the following day. I did put in the care plan teaching for mom about hygeine, especially since the kid has eczema he really needs to be clean and moisturized.

Lucidity · Feb 16, 2012

didn't you state above that his axillary was only 79.9 though?

ashleyv89 · Feb 16, 2012

It was a typo. Just mixed up the 7 and the 9 from typing too fast. Obviously there would be more nursing implications if he had a temperature of less than 80 degrees! I've never even seen someone with a temperature that low. There'd be a lot more wrong with him at that point.

Esme12, ASN, BSN, RN · Feb 17, 2012

That is why being precise is so very important. A typo can cause a patient to be treated for something that isn't present or real. I know some people get upset when spelling and grammar are corrected here........but a misspell can have huge implications and be a completely different drug, treatment, test, or result. A misspell, typo can have a huge effect on a patients care and outcome if not caught and can have a fatal outcome, especially on children.

I have seen temperatures that low as an emergency nurse and you are right......there is alot wrong with that vital sign, but possible on a trauma,if they were in the cold especially children. Temperature loss is a huge risk factor when dealing with trauma in the emergency room.

Peace.

just keep swimming · Feb 17, 2012

Esme, you are so great! Where the heck were ya when I was in nursing school??? Lol!

Esme12, ASN, BSN, RN · Feb 17, 2012

I don't know!!! :lol2: Sorry!

Actually I was probably working.......I am in a flair/progression of a rare neuromuscular disorder and stuck in a wheelchair, this keeps me sane. If you need help PM me.... :hug: