nursing diagnosis help

Circejane · Sep 5, 2009

I'd also think about risk for impaired healing d/t various things, including his diabetes. I'd also look at fall risk, which is a biggie (so is infection, but you have that). Self care deficit is a good one. I'd look at more than just what you've stated--what kind of home situation will he be discharged into? Does he have any comorbidities like CHF or renal failure? An 83yo diabetic with neuropathy is BOUND to have more going on with them--don't ignore other health issues and just focus on his admitting diagnosis.

I often wrote more than the required number of nursing diagnoses, with a note on the side stating why I felt it was appropriate to add another.

Your instructor may be different, but by the end of the first semester, my instructor told us she did NOT want to see any more "risk for infection" diagnoses. Not that they weren't important, they were, but they were also an easy one and she wanted us to really THINK. I would often add infection as an additional one, and state WHY I thought it was particularly appropriate for this patient (immunocompromised, wound in a place prone to get contaminated, etc.)

Talk to him/her about it, clinical instructors are there to help you. If they see that you're trying and not just asking them to do your thinking for you, you'll find that they really work hard to help you out. That's been my experience, at least.

GM910 · Sep 5, 2009

listed he has hypothyroidism and hypertension. besides a hernia repair 10 yrs ago and constipation in the past there is nothing else... is impaired healing a nanda diagnosis? it would be a good one, i just couldn't find it on the list.

thankyou for ur suggestions, i really appreciate the help

Circejane · Sep 6, 2009

How were his heart and lung sounds? His Bun/creat/GFR? His vision? It would be rare (and wonderful) for him to have no other complications from diabetes at his age.

The actual NANDA diagnoses that would apply to his wound would be Impaired Tissue Integrity, Ineffective Peripheral Tissue Perfusion, and at Risk for Delayed Surgical Recovery. I would note his peripheral capillary refill rate and distal pulses in the diagnosis, as they're sure to support it.

Is he compliant with his diet? Is he on insulin and compliant with that? You might look at the nutritional, blood sugar and teaching diagnoses. How about his HTN, is he compliant with meds and is that under control? Does he seem emotionally okay with losing a toe, or is he anxious, depressed or angry? Bunch of possible emotional diagnoses there.

One of the big things here is to be patient-specific, not condition-specific. You might have three patients with CHF, and all of them could have very different diagnoses, depending on their situations, attitudes, disease progression, etc. Think of this, too, when you're explaining meds to your instructor. It's not enough to know what a med is for and what it does, you need to identify why THIS patient is taking this med, and what it is doing for this specific patient.

Hope this helps, good luck! If you don't have a nursing diagnosis book, I'd advise getting one, they're bloody useful.

Daytonite, BSN, RN · Sep 7, 2009

i gave you a very detailed reply to your other thread which you should look at and apply the concepts to this case.

first of all you have omitted a great deal of assessment information and all you have provided is:

83 years old
medical problems
- diabetic neuropathy - what are his signs and symptoms beside a numb foot?
- hypothyroidism - what medications is he on? side effects?
- hypertension - on any medications? any symptoms of hypertension?
- hernia repair 10 years ago
- constipation in the past - having daily bm now?
[*]medical treatment
- had 2nd right toe amputated - where's your description of the wound and peripheral circulation assessment?
[*]assessment
- foot is numb - right foot? both feet?
- mainly on bed rest - by doctor' order? patient's preference?
- limited mobility - what does this mean? describe.
- assistance needed w/adls - what does this mean? describe.

- - - - - - - - - - - - - - -

in your other thread i showed you how a diagnostic statement was constructed (pes). you need a nanda taxonomy to help guide you as what are appropriate related factors (etiology) and defining characteristics (symptoms) of any diagnosis. the current one is nanda international nursing diagnoses: definitions and classifications 2009-2011, can only be purchased from nanda and contains all 206 diagnoses. this information is also in the appendix of current copies of taber's cyclopedic medical dictionary.

risk for infection r/t amputation of 2nd r toe

the related factor would be "surgical intervention".
because it is an anticipated problem (no evidence of an infection exists yet) it is the lowest priority and sequenced last.

self care defecit r/t 2nd toe amputation as evidenced by limited mobility and assistance needed w/ adls

there are 4 specific self care-deficits. does your nanda diagnosis list really just list
self care deficit
as a diagnosis? try using this nanda list:
http://wps.prenhall.com/wps/media/objects/3918/4012970/nursingtools/koz74686_appc.pdf
- 2007-2008 nanda-approved nursing diagnoses
limited mobility, depending on what it is and because is isn't described, sounds a lot like its probably
impaired physical mobility
.
the self-care deficits are specifically about not being able to accomplish adls. so, saying "
assistance needed w/ adls
" is merely restating the problem and not giving any of the symptoms.

immobility related to recent surgery of r. 2nd toe

this is not a nanda diagnosis.
you have provided no symptoms, so how did you even arrive at this diagnosis?

is impaired healing a nanda diagnosis? i just couldn't find it on the list

no, but there is a diagnosis titled
delayed surgical recovery
that includes such things as needing help with adls, needing more time than normal for healing to occur, problems with healing and difficulty moving.