Nursing Dx help please!

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Hi, I am struggling with my nursing dx and priority setting. Back round on patient; she is in hospital for having a hip fracture. waiting on sx for a couple of reasons; hemoglobin low, and infection from indwelling cath. Her important history includes chronic renal failure but not started on dialysis, DM- controlled by diet.

Patient is immobile, overweight, has 2 skin tears and pain seems to be unrelieved. My top 2 dx so far are ineffective tissue profusion rt decreased hemoglobin levels, and pain rt to fractured hip. Any help with the third nursing dx would be appreciated!

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Our Dx consist of; 1 physical. 1 psychosocial and 1 teaching.

Do you only have to do physical Dx?

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if you asked the patient, what would be the first thing she would want done?

Hi, I am struggling with my nursing dx and priority setting. Back round on patient; she is in hospital for having a hip fracture. waiting on sx for a couple of reasons; hemoglobin low, and infection from indwelling cath. Her important history includes chronic renal failure but not started on dialysis, DM- controlled by diet.

Patient is immobile, overweight, has 2 skin tears and pain seems to be unrelieved. My top 2 dx so far are ineffective tissue profusion rt decreased hemoglobin levels, and pain rt to fractured hip. Any help with the third nursing dx would be appreciated!

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How'd she break her hip?

(Fall?)

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Impaired skin integrity r/t her immobility?

Risk for electrolyte imbalance r/t CRF?

Excess fluid volume?

Impaired urinary elimination?

Impaired comfort?

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Think ADPIE

List all of your assessments. (the A) As the post stated above, the pt has chronic renal failure. One of your assessments is the objective data gathered by looking at her electrolytes. Are they abnormal? Even if you had previously not known she had CRF, you've got the D part because you see her electrolytes

You're diagnosis is???? Electrolyte imbalance. If they are normal: as stated: risk for electrolyte imbalance. P for plan. What would be you plan for someone with this nursing diagnosis? Then how would you intervene or what actions would you take? E for evaluate: evaluate whether or not your intervention worked. Then you have an outcome.

Another assessment: was she fatigued? Weak? What would be you nursing diagnosis for that? The related to is her decreased hemoglobin, as evidenced by???? How did you know she was fatigued? This is where you state HOW you know she has fatigue? Did she tell you?: Did you observe her inability to lift her fork to eat or sit up in the bed?

With NURSING diagnoses, do a head to toe assessment. List your signs and symptoms and identify a problem or multiple problems. There you have your diagnoses. You can add a diagnosis as you continue to observe her during your care for her.

You're going to be monitoring her diet. Even though she's obese, you notice for 3 days she's not really eating. This is an assessment . Then you assess further "why is she not eating? It could be due to her fatigue, or depression or other numerous factors. THAT'S what you get a dx from. What NSG dx would you give to someone not eating enough to get the calories and nutrition needed. She tells you its because she's depressed about her situation. You've got your dx, then come up with the rest of your dx statement. If she had the same dx but tells you its because she's too week, then you come up with your "related to" . As evidenced by remains the same because your assessment is the same. You've seen her full trays being picked up, maybe she verbally states she hasn't been eating because she's depressed

That's your evidenced by (your assessment.)

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Specializes in Hospice + Palliative.

a few that might fit what you've given, depending on your assessment:

impaired urinary elimination

impaired physical mobility

activity intolerance

anxiety (r/t pain)

impaired skin integrity (r/t decreased mobility)

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I just don't think its a good idea to spoonfeed diagnoses. OP, if you have all your assessments, all you need then is a good NANDA book. You can do it. You know more than you think you do. You assessed skin tears on your patient. With a NANDA book you could have come come up with impaired skin integrity on your own and have felt a sense of accomplishment knowing YOU came up with it with the resources you already have.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Hi, I am struggling with my nursing dx and priority setting. Back round on patient; she is in hospital for having a hip fracture. waiting on sx for a couple of reasons; hemoglobin low, and infection from indwelling cath. Her important history includes chronic renal failure but not started on dialysis, DM- controlled by diet.

Patient is immobile, overweight, has 2 skin tears and pain seems to be unrelieved. My top 2 dx so far are ineffective tissue profusion rt decreased hemoglobin levels, and pain rt to fractured hip. Any help with the third nursing dx would be appreciated!

I agree with sleepyRn...we are happy to help with homework but it will do you no good for the information to be given to you. It will not make you the best nurse you you can be. You have had many helpful suggestions......what care plan book do you have? It is necessary to have a good care plan book. I use Aclkey. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care

What care plan book do you have? This is a must have tool even if your school has not "required" or "suggested" it. Nursing diagnosis are based on specific definition, the reason why it would apply, and symptoms that prove their existence

For example.....ineffective tissue profusion (rt decreased hemoglobin levels). NANDA describes ineffective tissue profusion as......Ineffective peripheral tissue Perfusion or Impaired Tissue integrity

Impaired Tissue integrity: NANDA-I Definition

Damage to mucous membrane, corneal, integumentary, or subcutaneous tissues

Defining Characteristics (as evidenced by)

Damaged tissue (e.g., cornea, mucous membrane, integumentary or subcutaneous tissue); destroyed tissue

Related Factors (r/t)

Altered circulation; chemical irritants; fluid deficit; fluid excess; impaired physical mobility; knowledge deficit; mechanical factors (e.g., pressure, shear, friction); nutritional factors (e.g., deficit or excess); radiation; temperature extremes

OR Ineffective peripheral tissue Perfusion NANDA-I Definition

Decrease in blood circulation to the periphery that may compromise health

Defining Characteristics (AEB)

Absent pulses; altered motor function; altered skin characteristics (color, elasticity, hair, moisture, nails, sensation, temperature); blood pressure changes in extremities; claudication; color does not return to leg on lowering it; delayed peripheral wound healing; diminished pulses; edema; extremity pain; paraesthesia; skin color pale on elevation

Related Factors (r/t)

Deficient knowledge of aggravating factors (e.g., smoking, sedentary lifestyle, trauma, obesity, salt intake, immobility); deficient knowledge of disease process (e.g., diabetes, hyperlipidemia); diabetes mellitus; hypertension; sedentary lifestyle; smoking

Your patient must fit this definition...id they do not you need to find another diagnosis. How does a decreased hemoglobin effect tissue perfusion?

******Care plans are all about the assessment.....of the patient. Tell me about your patient, What is your assessment? What do they NEED? What is their main complaint? What are their co-morbidities? How old is this patient? What is their base line? What meds are they on?

YOU MUST have a good care plan book with the NANDA diagnosis and it defining characteristics.

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

ADPIE

  1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
  3. Planning (write measurable goals/outcomes and nursing interventions)
  4. Implementation (initiate the care plan)
  5. Evaluation (determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

THese sheet may help you out.....daytonite made them (rip)

critical thinking flow sheet for nursing students

student clinical report sheet for one patient

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Now....tell me about your patients assessment...what do they NEED right now.

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I'm surprised no one mentioned Acute pain r/t hip injury aeb patient stating pain '8' out of 10

Managed pain = increased mobility = better tissue integrity/perfusion

Just my thought but I also agree.. A little help from others is nice but this is something you must master and practice will certainly make perfect as I could list 10 dx's off of what you shared...so you have enough info

Hang in there!!

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