nursing diagnosis

oh, yes, she has ineffective tissue perfusion. she will end up having that hip disartic and then get worse, poor thing.

i'll bet she's also a bad diabetic, which is why she has had serial amputations for ischemia. if she isn't, why did she have the first amputation? but i'll bet she is.

look up dm, ischemia, and peripheral arterial disease, and see if that gets you some ideas. let us know what you find!

I have to break down all that "r/t" and "AEB" and put it in my own words. First things first: you have to pick a nursing diagnosis. So here's the process in my own words:

1) Nursing diagnosis ("What are my patient's issues? What complications could she have?") This is all very individualized; is she having pain? (Nursing diagnosis would be "Acute pain.")

2) R/T or "related to" ("What makes me think that this nursing diagnosis applies?") Well, if she is having pain, it's due to her surgery, right? So..."Acute pain r/t surgical procedure?" Yes. But you may have to be a little careful here...some instructors like you to stick to the "related to" options presented by NANDA. So review your care plan book, if they have provided you one, and make sure your "related to" applies to your patient.

3) AEB or "as evidenced by" ("What evidence do I have that the patient really has this problem?") Well, is she writhing around, guarding the incision area? Is her heart rate up? Is she crying? Perhaps she is stoic but rating her pain 9/10...again, this is all very individual. Let's say your patient is tearful and holding the incisional area. Now we have "Acute pain r/t surgical procedure AEB tearfulness and guarding of incisional area."

At this point, you can work on interventions...what do you, as a good nurse, want to do to help the patient with this particular problem. You say you will assess her pain? Good, but not specific enough. We need something measurable. "Assess pain hourly using the 0-10 pain scale?" Better.

You will give pain meds? Awesome, but again, not specific. What will you be giving? How often? How will you know if it works? That's the thought process.

Evaluation of outcome should also be very specific. Don't just say "Pain will be better." Find out from the patient what an acceptable pain rating is for them, and make that your goal.

NANDA diagnoses provide the framework, but you have to individualize them to your patient. Nothing irks instructors more than getting generic care plans. If your patient is jolly and joking, then an "anxiety" care plan isn't helping anyone.

Whew. That was long....hope this helped a little as far as how to break down the pieces of the nursing diagnosis.

Disturbed Body Image, Impaired Mobility....

possible activity intolerance.

All r/t Amputation.

No, this patient was not a diabetic, she told me that she kept having blood clots really, really bad so that was the reason for the amputation to begin with. Once the doctors did the first amputation, her tissues would not heal.

aha, a zebra! (this is a reference to the classic "house of god," in which it is noted that upon hearing hoof beats outside the window, the medical student thinks of a zebra. the lesson is that you always think of the more common diagnosis first, and if that doesn't pan out, only then do you go for the less likely one.)

so, this lady has some sort of hypercoagulable state? or does she have something like atrial fibrillation, aortic or ventricular aneurysm where she's growing clot? or did she have some other sort of vascular injury? what is it? what other effects would that have?

whatever, she's at possible risk for more such incidents in other areas (depending on the cause); what happens when you get clots in your arteries?