MB37 1,714 Posts Nov 4, 2007 Thanks Daytonite! My book calls that 3rd one Impaired Adjustment. However, it's not in the index. I really need a new care plan book. She is type I, went into a coma at age 5 when she moved to mainland US (from PR). She said she was in the coma for 6 months, and when she came out of it she had a lot of mental issues - biting people, growling at them, etc. Her HCT was 39.5 when she was admitted, then dropped to 34.5 the next morning, 35.2 5 hours later, and 36.9 when I saw her. I'm only supposed to write interventions and evals for one diagnosis, the highest priority - so you say this would be the activity intolerance? Of course, I'm also supposed to write what I actually did during my 6 hours, to address the needs that I perceived while I was there, and all I did was teach and chat with her, made sure the HOB was elevated, rechecked vitals, etc. - only what I've learned in Fundamentals. My nurse had 4 other students (no idea why, I was on a new floor, it was always 1:1 on my previous one - maybe she was the only RN?) and they were all passing meds, so she didn't have time to talk to me or my patient really, unless I came and got her for something. I asked my instructor for ideas for interventions when she came around, and all she suggested was to make sure she knew how to get meds if her mother forgets again. None of the interventions in my book for activity intolerance really apply to a young person, especially one who has a job where she's on her feet for 8 hours a day, and we have to provide a rationale for everything we use, with a reference (supposed to be from our care plan book).
Daytonite, BSN, RN 4 Articles; 14,603 Posts Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience. Nov 4, 2007 well, actually, i was basing my choice of nursing diagnoses on the assessment information you had listed and maslow's hierarchy of needs. however, my gut tells me that diagnosis #3 (risk-prone health behavior r/t [either inadequate comprehension of disease state or negative attitude toward health care] aeb administration of incorrect type of insulin after forgetting to purchase the correct type necessary that resulted in dka and patient being hospitalized (teaching needs related to diabetes can be included as nursing interventions under this diagnosis)) is the one you should go with. this is a type i diabetic who needs major teaching and an attitude adjustment. shame on her and her mother for getting her into this situation in the first place.i had a friend years ago who was a type i and did this and other foolish stuff like this all the time. he would eat all kinds of sweets and then inject himself with a couple of units of regular insulin to cover his eating. he had such a bad attitude about his disease. i wonder if he's still alive today. i also worked at a hospital that had a 25 year old type i diabetic who was blind from her disease (no kidding) and guess what her job was? she developed the x-rays in the dark room in the radiology department. this was years ago before digital.when these young type i diabetics with "i can live forever" attitude (that, by the way, is part of their developmental level thinking) do this kind of stupid stuff and don't follow a good plan and control their disease they develop complications early in life and die early deaths. i would suspect that this young lady's high blood pressure is a symptom of something going on yet to be discovered. db's are notorious for cardiovascular disease and atherosclerosis. i would worry that the anemia may be an early problem of renal disease. renal problems don't manifest until the damage is done. a good many chronic renal failure patients are diabetics. it takes a number of years for these conditions to develop, but these could be warning signs.i'd list the activity tolerance next, then grieving and finally the risk for injury. the worst that can happen it that you get dinged for sequencing the nursing diagnoses incorrectly. you might pass it by your instructor first before handing the care plan in. the diagnosis, risk-prone health behavior, is right out of my 2007 nanda reference book, so that is the current title for that diagnosis. it was previously titled impaired adjustment, but was changed by nanda in 2006. i had to do a little hunting to find it for you, but i knew there was something that was funky and between noncompliance and health maintenance. ineffective health maintenance just doesn't quite fit here if you read the taxonomy that describes it.
OnTheRoad 177 Posts Nov 4, 2007 My main point with this med vs nursing dx... is do your own assessment and plan the care accordingly. By looking for a nursing dx from a medical one does not address the patient. I have been seeing this all over the boards... I need a nursing dx for XXXX disorder. WHY? You saw the patient...and you can only formuate your nursing dx from a well done assessment, from what you actually saw.I was trying to help her explore the patient and not the medical diagnosis.I don't know if anyone has mentioned this, but in my program we have to go the night before clinicals and gather information about labs and diagnosis (medical) etc. We are not allowed to go near the patient. I usually look at assessment data from the last 24 hrs as well so I can at least have somewhat current data to go on, but I have to formulate my DX and care plans initially based upon only what I have read. After patient care day, we go back and adjust for what we actually saw during our assessments etc. It can be very difficult to formulate correct DX and interventions based on only lab values and md DX, but some of us have to make our best guess at what we MAY be looking at when we actually get access to the patient.
MB37 1,714 Posts Nov 5, 2007 No, we're not allowed to go in the night before. Our preceptor assigns us a patient in the morning after report. Daytonite, thanks again - I'll see what I can find on that dx, I think I'll stop at a bookstore after class and see if I can find another CP book too - I just don't like how mine is organized. Or I'll just order the one from NANDA that you've mentioned before. I really appreciate the assistance - I've been reading your posts for so long on here, now I'm finally at the point where I need your wealth of knowledge as well! I'll just list the risk-prone dx first, and if I get dinged I get dinged. It's what I prioritized while I was there, right or wrong, so that's what I'll go with. Thank you!
GeauxNursing 800 Posts Specializes in Dialysis. Nov 5, 2007 Home maintenance management, impaired? would that relate to the fact that she didn't have the right kind of insulin to admin.?I'm just starting care plans, too.
Daytonite, BSN, RN 4 Articles; 14,603 Posts Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience. Nov 6, 2007 home maintenance management, impaired? would that relate to the fact that she didn't have the right kind of insulin to admin.?i'm just starting care plans, too.i think this was a difficult case to diagnose. when i look at a reference for this particular nursing diagnosis that you are suggesting, this is what i find it says (page 105, nanda-i nursing diagnoses: definitions & classification 2007-2008):"impaired home maintenancedefinition: inability to independently maintain a safe growth-promoting immediate environment.i think that is a problem already. this was not a growth-promoting problem. this was a young adult who was not managing her medical problem correctly. not only correctly, but made a deliberate choice to use the wrong insulin knowing it was the incorrect insulin to use.related factors:deficient knowledgediseaseinadequate support systemsinjuryimpaired functioninginsufficient family organizationinsufficient family planninginsufficient financeslack of role modelingunfamiliarity with neighborhood resourcesdefining characteristics:objective:disorderly surroundingsinappropriate household temperatureinsufficient clothesinsufficient clothesinsufficient linenlack of clotheslack of necessary equipmentoffensive odorsovertaxed family memberspresence of verminrepeated unhygienic disordersrepeated unhygienic infectionsunavailable cooking equipmentunclean surroundings[*]subjectivehousehold members describe financial criseshousehold members describe outstanding debtshousehold members express difficulty in maintaining their home in a comfortable fashionhousehold members request assistance with home maintenance"not sure any of these defining characteristics fit the patient's symptoms either.
