Nursing Dx: Do these look ok?

Daytonite, BSN, RN · Apr 23, 2007

here's the changes i would make and why:

impaired physical mobility related to decreased strength and endurance secondary to acute left ankle pain, sedentary lifestyle, and osteoporosis as evidenced by slow and infrequent ambulation and patient states, "i wish i could get around better."

sedentary lifestyle is a related factor for this diagnosis. also, acute left ankle pain is a subjective symptom and my feeling is that it should not be used as an etiology. if you know what is causing the pain (such as the osteoporosis) then i would use that instead. also, you have "unsteady gait" included as a related factor on your risk for injury diagnosis. unsteady gait is a symptom that belongs with the aeb items of this diagnosis. the parkinson's disease is playing a big factor in the physical mobility problems and you didn't mention it. i would re-write this as:

impaired physical mobility related to decreased strength, decreased endurance and sedentary lifestyle secondary to parkinson's disease and osteoporosis as evidenced by slow and infrequent ambulation, unsteady gait and patient statement "i wish i could get around better".

acute pain related to inflammation of left ankle joint as evidenced by +3 pitting edema and client reports pain score of 3 on scale of 1 to 10.

edema is not a symptom of pain which is what this nursing diagnosis is about. the pain is due to swelling caused by the inflammation. i would re-write this as:

acute pain related to inflammatory process in left ankle as evidenced by client report of pain score of 3 on a scale of 1 to 10.

disturbed body image related to change in appearance secondary to loss of teeth and gums resulting from osteoporosis as evidenced by client states, "i do not like to wear earrings because it draws attention to my face and people will notice my mouth," and "i would give anything to have teeth."

the definition of this nursing diagnosis is "confusion in mental picture of one's physical self". i think your etiology here is more one of the person's self-perception rather than a change in their appearance. a change in appearance would suggest to me that this change is something that has occurred recently. call me ignorant, but i wasn't aware that people lost their teeth (and gums?) from osteoporosis. my dental hygienists have been telling me for years that gum disease and tooth loss is due to plain old neglect of the teeth (not brushing and getting regular cleanings).

disturbed body image related to self-perception secondary to full mouth dental extractions as evidenced by client statements, "i do not like to wear earrings because it draws attention to my face and people will notice my mouth," and "i would give anything to have teeth".

risk diagnoses

risk for injury related to history of falls, decreased mobility, and unsteady gait secondary to sedentary lifestyle, osteoporosis, and parkinson's disease.

this is a safety diagnosis that has to due with potential sources that could cause injury in some way. it's redundant to use a history of falls as a related factor since it is it's own diagnosis. what is it in the patient's movement or the physical setup of the environment in which he moves around that makes it a risk for him to incur an injury?

risk for injury related to slow reactions and altered gait secondary to parkinson's disease.

risk for falls related to history of falls, decreased mobility, and unsteady gait secondary to sedentary lifestyle, osteoporosis, and parkinson's disease.

i don't see a relationship between a decreased mobility, sedentary lifestyle and osteoporosis increasing the patient's susceptibility to falling.

risk for falls related to history of falls and unsteady gait secondary to parkinson's disease.

risk for ineffective coping related to chronic diseases and history of psychological disorders.

the definition of this diagnosis would be at risk for the "inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources." the related factors of this diagnosis include things like a disturbance in a pattern of appraisal of threat, disturbance in a pattern of tension release, gender differences in coping strategies, high degree of threat, inability to conserve adaptive energies, inadequate level of confidence in ability to cope, inadequate level of perception of control, inadequate opportunity to prepare for stressor, inadequate resources available, inadequate social support created by characteristics of relationships, maturational crisis, situational crisis, and uncertainty. it is not related to chronic disease and a history or psychological disorders.

i have no opinion as to which diagnosis would be the one to do for a care plan.

BBQvegan · Apr 23, 2007

Oh my goodness! Thanks so much for your input! What a fantastic resource you are! I will review all these suggestions when I make my edits this afternoon. You are teaching me so much about nursing diagnoses!

Daytonite, BSN, RN · Apr 23, 2007

You are welcome. Good luck with this paper.

BBQvegan · Apr 24, 2007

Daytonite, I just wanted to respond that the client told us her doctor explained to her that the atrophy in the bones caused the tooth joints to loosen and teeth to fall out. She is unable to wear dentures because the gums or bones are disintegrated. I had not heard of that either, but it sounds legit, no?

Daytonite, BSN, RN · Apr 24, 2007

I've never heard of that, but that doesn't mean it can't be wrong. It would be nice if it had been documented by the doctor. All it will do is change the wording on your Disturbed Body Image diagnosis "related to" item to something like "loss of dental structures secondary to (the disease process if you know what the name of it is)", I suppose. I think I would really try to find some pathophysiology to try to back that up if only to satisfy myself that it was true.