Nursing diagnosis help

[Stoogesfan]

My client had diabetes mellitus and his morning accucheck was 172. For breakfast he had a sausage, egg and potatoes bowl, orange juice and a cinnamon roll.

So for my nursing diagnosis I was thinking either ineffective self health management or risk for unstable glucose level.

I was considering possibly knowledge deficit but he told me that he didn't think orange juice was ok to have but since it was on the menu he figured they (the hospital cafeteria) knew what he could and couldn't have.

What does anyone think of those?

[Stoogesfan]

If this were real life you would focus on the reason for admission. The patient is not left in acute chest pain but still needs interventions to prevent the chest pain from recurring. The nurses are probably intervening and preventing the pain via their care plan hence why you didn't pick up the pain in your assessment. Also, we don't change a care plan once the issue has resolved. For example if a patient was post op knee and had a femblock to prevent pain and was pain free, my care plan would still include acute pain because we are preventing the pain and intervening. The problem doesn't go away until their is actual resolution or the matter no longer needs focused interventions. What causes cardiac chest pain? Lack of oxygen to myocardial tissue by occlusion of an artery, leading to anaerobic metabolism, with lactic acid being released. Was your patient on supplemental oxygen? if yes, this could be helping the chest pain by increasing the oxygenation to the heart eliminating the pain. Was he on bedrest? When you get up and move around you need more blood so the heart works more and requires more perfusion. As an acute care nurse I would not even consider a sugar of 172 a problem, it is ideal for a diabetic to be in that range or slightly lower. That is the only reason I mentioned I would still focus on the chest pain as the main reason that patient is hospitalized. The care plan in reality tells you what you need to focus on and what your interventions should be. We develop a care plan on admission and continue to assess the problem, lets say they determine that the reason the patient came in with acute chest pain was related to not taking his anti-reflux medication and he had gas and ate an extra spicy/fatty meal before bedtime, then you would want to focus on knowledge deficiency, which would be the main root of the acute pain. It is hard to formulate a care plan without assessing a patient, you have assessed the patient, go with your gut instinct. I just think you could better defend a care plan that addresses the main reason the patient is in the hospital. You don't sound like an idiot asking questions, I see the students come to the floor with their nursing instructors and it is frustrating to see how nurses are being trained. They spend more time sitting at the computer looking at labs, H&P's, xray results writing down normal values, the instructors spend 15-20 minutes with the students and don't assess the patient themselves before telling a student what the nursing diagnosis should be. If the patient has a pending stress test echo and it turns up positive you would change your care plan to ineffective tissue perfusion, and negative the care plan would be resolved and patient usually discharged.[/quote']

That makes so much sense now. Thank you so much for taking the time to help. It's already turned in so I can't change it but I will do better on the next one :)

[Esme12, ASN, BSN, RN]

That makes so much sense now. Thank you so much for taking the time to help. It's already turned in so I can't change it but I will do better on the next one :)

Maxnure has goven you great advice for the real world...remember it is your instructor who will be grading you.

[Kuriin, BSN, RN]

The famotidine was new but the rest he had been on for quite some time.

Why was he placed on a H2 antagonist? (Sorry if you answered this already...)

I would not even consider a sugar of 172 a problem, it is ideal for a diabetic to be in that range or slightly lower.

Really? That seems pretty high to me. Diabetics should range from 70-130 and non-diabetics should be 70-100.

You ain't an idiot, btw. It is great you're questioning things. :)

[nurseprnRN, BSN, RN]

Hmmm never even heard of that book. I have Ackley's nursing diagnosis book.

Thanks for the help. I will definitely look for that one :)

Seriously? NANDA-I 2012-2014 is the only definitive nursing diagnosis book because it's put out by NANDA-I, what used to be called "north american nursing diagnosis association." Then it went international and got shortened to "NANDA-I." This is where all approved nursing diagnoses come from; if they aren't in there, they aren't approved. You have to have this even if your faculty forgot to put it on the bookstore list. :)

[MattNurse, MSN, RN]

Really? That seems pretty high to me. Diabetics should range from 70-130 and non-diabetics should be 70-100.

I would be more concerned if I had a diabetic patient on insulin around 70, less concerned with a sugar of 172, I would still cover the sugar at meal time. Even though 70 falls in the ideal range for a diabetic, I would monitor that level closer then the level outside the norm. Hypoglycemia is far more troublesome then mild hyperglycemia for a known diabetic. Most sliding scales for diabetics don't even call for coverage until 150.

[MendedHeart]

I agree with above post. Also, what if they ate within the last few hours.