Nursing Diagnosis

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Specializes in aged & med/surg.

Hi all, I am doing my first care plan and need help with nursing diagnosis for the following senario:

As an occupational health nurse employed by a mining company 700kms north of Adelaide, one of your primary responsibilities is to provide information to all employees about healthy lifestyles. While waiting in the kiosk line at lunchtime one of the machine operators, Stanley Harris, asks if he may talk to you sometime about some things he doesn't understand. Stanley, a 46 year old Indigenous Australian, tells you his doctor told him he has hypertension and that he must take medication everyday. He tells you that he doesn't take his medication as he feels fine. Stanley also shows you a script he has for Verapamil 120mg daily. 'This is what the doctor gave me, but I feel fine. I don't think I'll get it filled right now.' Nursing assessment reveals: temperature 36.4 C, pulse 94, respiratory rate 20/min, blood pressure 186/100 and weight 119kgs, height 1.70m.

Any assistance would be great, I feel there isnt much in the senario except for the education side.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
i am just starting with care plans and would love some advise on nursing diagnosis for someone with hypertension in the community. here is the description:

as an occupational health nurse employed by a mining company 700kms north of adelaide, one of your primary responsibilities is to provide information to all employees about healthy lifestyles. while waiting in the kiosk line at lunchtime one of the machine operators, stanley harris, asks if he
may talk to you sometime about some things he doesn't understand
. stanley, a 46 year old indigenous australian, tells you his
doctor told him he has hypertension
and that
he must take medication everyday
. he tells you that
he doesn't take his medication as he feels fine
. stanley also
shows you a script he has for verapamil 120mg daily.
"this is what the doctor gave me, but i feel fine. i
don't
think i'll get it filled right now." nursing assessment reveals: temperature 36.4 c, pulse 94, respiratory rate 20/min,
blood pressure 186/100
and weight 119kgs, height 1.70m

you asked for advice on a nursing diagnoses for someone with hypertension. first, you must understand that nursing diagnoses are not based upon patient's medical diagnoses. hypertension is a medical diagnosis and not a decision that a nurse can make. nursing diagnoses are based upon a nurse's assessment of the patient. if you, the nurse, find that the patient's blood pressure was elevated during your assessment, then you will list this as elevated blood pressure of 186/100 (as in this particular case).

here is the assessment information you were given in this scenario and upon which you must determine your nursing diagnosis:

  • the patient left his doctor's office not understanding everything he was told
  • the doctor told him he had hypertension
  • the doctor gave him a prescription for medication, but he hasn't taken it because he feels fine
  • he has a prescription for verapamil 120mg which he has not gotten filled and doesn't plan to get filled
  • elevated blood pressure of 186/100

the scenario is not listing any other physical symptoms of his hypertension. there are no specific nursing diagnoses for a patient with hypertension. quite honestly, what are you, as a nurse, going to be able to do for a patient with a blood pressure of 180/100 without a doctor's order? that is the idea behind writing a care plan: what can you, as a nurse, do for the patient that the doctor can't necessarily do, that you can do without a doctor's order, and that you can add to what the doctor has already done? as a nurse you have to stop thinking so much like a doctor (although you need to know what the doctor is likely to order) and think more about how you can be of service to the patient based upon what you, the nurse, have been trained to do with patients.

you need to look up verapamil and note why it is given and the side effects, if any of this drug. you need to understand that verapamil is given for other heart problems as well as hypertension. you need this information for the teaching information you are going to give this patient. you also need to look up information on the treatment of the medical diagnosis of hypertension. as a nurse, you still need to know what the physician is likely to order for the patient, and, most importantly, why. if this were an actual patient i would sit down with him and question him further about what the doctor told him to get a better picture of why he has chosen not to take this medication and why he is now curious about it and hypertension.

the suggestions i would give you for nursing diagnoses for this patient are as follows and i've carried them out to a three part nursing diagnostic statement which is often what nursing instructors here in the united states want students to do to show that they understand the critical thing behind the use of the nursing diagnoses and the nursing process:

i would tend to go with the diagnosis of noncompliance since you are able to encompass all the patient's abnormal assessment items within it. you can include all the teaching that the patient needs as nursing interventions under this diagnosis with the way i have worded the 3-part nursing diagnostic statement. you can't do it as effectively with the ineffective coping nursing diagnosis. just so no one thinks i'm giving an off-the-wall nursing diagnosis here, the definition of the noncompliance diagnosis is "behavior of person and/or care giver that fails to coincide with a health-promoting or therapeutic plan agreed on by the person (an/or family and/or community) and healthcare professional. in the presence of an agreed-on, health-promoting or therapeutic plan, person's or caregiver's behavior is fully or partially nonadherent and may lead to clinically ineffective or partially ineffective outcomes." (page 146, nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international) notice that they use the nondescript word "fails". when the person went to the doctor and accepted the prescription from him, he was agreeing to follow the doctor's therapeutic plan. otherwise, he could have crumbled up the prescription, threw it on the floor, laughed in the doctor's face and said, "i don't need this." maybe he's passive aggressive. more importantly, it's not our task to determine that because that is another medical diagnosis!

please check out the posts on this thread on the nursing student assistance forum for lots more information on how to formulate a nursing diagnosis

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