Nursing Diagnosis assistance....please!!

Published

Specializes in Telemetry, PCU, Private Duty, Hospice.

Hi,

I am in my 2nd semester of nursing school and I am writing a paper on Iron Deficiency Anemia with a partner. In the paper, we have to include two developed care plans for a client with IDA. One of our care plans will be using NANDA diagnosis: Imbalanced Nutrition, less than body requirements. However, I am having trouble trying to figure out which NANDA diagnosis to use for the second: Fatigue or Activity Intolerance. In our Med-Surg textbook, Fatigue is listed as the #1 nursing diagnosis for Anemia, however in a nursing journal article I have and in the care plan book I am using, it seems like Activity Intolerance is the most appropriate nursing diagnosis.

Can someone please provide me some advice on which nursing diagnosis I should use and why??? The fictitious patient we compiled for our paper is a 30-year-old female who presented to the ER with lack of energy/fatigue, shortness of breath, dizziness, weakness, and irritability. She also has a history of Celiac Disease, but admits non-compliance with her diet as manifested by abdominal bloating, diarrhea, and weight loss. (I haven't compiled the CBC results yet...but everything will point to IDA w/ need for blood transfusion)

Possible diagnostic statements:

Fatigue related to decrease in hemoglobin as manifested by verbalization of lack of energy and increased periods of rest.

--or--

Activity Intolerance related to imbalance between oxygen supply and demand as manifested by fatigue and increased periods of rest.

I am at a loss for which diagnosis to use for IDA--which is most appropriate for IDA...not necessarily for our fictitious patient.

Thanks in advance for your advice!!! :D

Up Vote Up Vote ×
Specializes in Med/Surg, Ortho, ASC.

Take a quick trip down memory lane....if allnurses.com didn't exist, which nursing diagnosis would you choose? Oh - you say you weren't in school prior to allnurses.com? Well then....

Asking us to help you write your paper/answer your exam questions/determine your nursing diagnosis is not possible. You must determine your own NANDA diagnosis, answer your own questions through research, and write your own paper via more research.

You can do it! Go for it!!!

Up Vote Up Vote ×

If i had to choose i would go with fatigue. Fatigue is one of the main symptoms that women complain of when thay go to the doctors and find out they are anemic!

Up Vote Up Vote ×
Specializes in Telemetry, PCU, Private Duty, Hospice.

Dear Roser13 -- ;-) I understand the message loud and clear!! I will definitely do more research, and try to find the research to back up my instincts!! I am just overly conscientious...especially when another student's grade hinders on my decision (right or wrong). Thank you very much!!

Dear Melibell24 -- Thank you for your advice.

Up Vote Up Vote ×

Use Fatigue......it's simple & makes perfect sense. The other one is just too complicated. If there is one thing that I learned out of nursing school...that is KEEP IT SIMPLE!! I cannot stress that enough....try not to "over think" things & especially during your clinicals, Nursing is easy not rocket science... so just relax & take a deep breath, Good luck to you in school!

:)

Up Vote Up Vote ×

Why does your patient need a transfusion? Doesn't anyone know about iron INFUSIONS? I realize in a situation where it is urgent a transfusion is necessary, but IDA can be treated with just iron infusions through an IV....

*this is only a patients point of view, please don't take this any other way*

I suffered from IDA levels as low as 6.5 for years... took pills forever, no difference, finally saw a hematologist who told me to take more pills. Then when I was about 6 months pregnant my OB freaked out my levels were too low and sent me to a different hematologist, who right away sent me for IV iron infusions and after 3 weeks and 5 sessions of 30 mins each, my levels were perfectly normal. The first hematologist didn't even know about, or at least didn't mention this treatment. He told me there are "shots" but they are painful, and sent me on my way with an iron pill prescription.

Just food for thought....

Amber

Up Vote Up Vote ×
Specializes in Telemetry, PCU, Private Duty, Hospice.

Thank you for your help! I really appreciate the suggestions :-)

Up Vote Up Vote ×
Specializes in Infusion, Med/Surg/Tele, Outpatient.

Amber, most nursing instructors don't want their students even ficticiously giving Infed. ;)

Up Vote Up Vote ×

What is "Infed" is that the name of the iron infusions? (I'm only a pre-nursing student, so that's why I was giving patients perspective).

It seems like many providers don't know about iron infusions, but they know about TRANSfusions.... Why is this?

I have an appointment on monday with the hematologist (i'm anemic this pregnancy also), and I'm curious, so I will be asking him about it.

Up Vote Up Vote ×

interesting thought. I am in nursing school myself, yet every time I have had a patient with extreme anemia/ iron deficiency we always did blood transfusion. not sure if they have the iron one you are talking about.

Up Vote Up Vote ×
Specializes in Telemetry, PCU, Private Duty, Hospice.

Regarding your question about why I wanted to give my fictitious patient a blood transfusion, it's because it seemed to be the treatment of choice for 2 patients that I've had on clinical who had anemia. My patients did not have IDA though. They had cancer, so it was a different disease process that caused the anemia. My fictitious patient has Celiac Disease, so she is more prone to GI bleeding/blood loss in which a blood transfusion may be needed, depending on the amount of blood loss.

I am still working on my research for IDA, and transfusions are not meant for every patient because of the associated complications (and even religious beliefs). But, if a patient is bleeding and they are symptomatic, a blood transfusion may be the only treatment to get oxygen to the body tissues quickly....I have seen this in one of my cancer patients who went into respiratory distress....very scary!! I have only witnessed blood transfusions for anemic patients on clinical, and haven't seen IV iron infusions or even EPO therapy, so I'm less likely to chose a treatment for my fictitious patient that I haven't seen yet. I've seen what a blood transfusion does and speed at which it works. I don't know the time frame in which IV iron and EPO works, and my research also did not specify this information.

I am surprised that if your Hemoglobin was in the low 6's, that you were not given or offered a blood transfusion as treatment. That is severe IDA!

Anyway, thank you for giving me the patient perspective. I thankfully have not had anemia, so I don't know what it feels like first hand (my paper partner has had it though). I am still learning and still doing research, but will never be an expect. ? Congratulations on the new baby coming!!

Up Vote Up Vote ×

When it was 6.5 I was told by an OBGYN that I was at risk of a heart attack! One day at work I had a panic attack, that I thought was a heart attack, because the doc had told me I was at risk for one... went to ER, diagnosed with panic attack, and anemia, but still no treatment for IDA. (this was 3 or 4 years before I was pregnant) I was seeing her for menstrual bleeding, the cause of the IDA originally. My levels were 6.5 to low 7's for about 5 years total. Every doctor I went to until the most recent hematologist, said "take iron pills" or gave me a prescription iron pill.

I tried multiple brands of iron. You think they would suggested an alternate treatment also due to the fact I had lateral gastrectomy with biliopancreatic diversion and duodenal switch in my history (bariatric surgery). Which is why I don't absorb iron pills. I don't have any problems absorbing any other vitamins or nutrients though, just iron.

It seemed to me the docs didn't want to do something as drastic as a transfusion, but were unaware of the infusions as treatment.

My friend recently was diagnosed with celiac and she was at 4.5, and rightly so, they did immediate transfusion.

Up Vote Up Vote ×
+ Join the Discussion