nursing dx okay?

PNWNusingStudent · Dec 10, 2008

I am really new to nursing dx but I think you may be on the right track by switching the r/t with the AEB's. Would it not be Disturbed body image rt presence of trach tube and the AEB would be the signs and symptoms of disturbed body image like those in the NANDA?

Like I said I am really new so hopefully Daytonite will come on and help you. Sorry I know I am not much help.

LiliyaRN · Dec 10, 2008

you should really not switch them. Although it may sound better, nursing dx are designed to first state what they are r/t to and then they expain what it is evidenced by.

Daytonite, BSN, RN · Dec 10, 2008

disturbed body image rt abnormal opening in neck aeb presence of trach tube.

i keep wanting to swap the rt and the aeb!

the thing is that "abnormal opening in neck" and "presence of trach tube" are both the same thing just stated in different words. if you read the definition, related factors and defining characteristics for this diagnosis a few things become apparent:

this problem is about a person's "confusion in mental picture of one's physical self". (page 364,

manual of psychiatric nursing care plans: diagnoses, clinical tools, and psycopharmacology

by elizabeth m. varcarolis, 2006). keep in mind that the r/t part of your nursing diagnosis has to be the underlying cause of this problem. this is primarily a psychosocial diagnosis. a trach might be setting off this mental confusion, but something else could also be the underlying cause. lots of people have medical things happen to them and don't freak out over it. the underlying cause could also be something like feelings of helplessness, fear of rejection by others, perception of functional impairment, perception of disfigurement or low self-esteem. from my experience as a med/surg nurse i might also consider

fear of rejection by others

or

perception of disfigurement

not knowing anything else about this patient.

the patient's

response

to the trach are your defining characteristics (symptoms) for this diagnosis. i worked on a stepdown unit where we had lots of trach patients on vents. i've had patients who either got terribly depressed or awfully anxious with them. they would point to them (remember they can't talk) and make all kinds of faces, clear evidence that they didn't like them. they would do everything they could think of to hide them when visitors were coming. thus, we had clever little hoods or scarves of light material that could be tied around their necks to hide them. some would have nothing to do with their trach care or their sputum and became totally dependent on the nursing staff for all things trach care related. talk about the trach and they lost eye contact with you. some would get super anal about every aspect of their trach care to the point of not letting the nurses do anything with them.

keep in mind that the aeb stuff is what you saw, or evidence (clues) that you found, which convinced you (proved) that you had a problem of

disturbed body image

(

confusion in mental picture of one's physical self

). the idea of the written care plan is to convince your instructor of your sound critical thinking in this situation. collect the clues, put them together correctly, attach the right label (nursing diagnosis) on them and you have yourself the start of a care plan.

you can do:

disturbed body image r/t tracheostomy aeb [ex: hiding the trach, refusing to let others see it, s/s of depression or anxiety when the subject of the trach is brought up]
disturbed body image r/t fear of rejection due to tracheostomy aeb [evidence]
disturbed body image r/t perception of disfigurement due to tracheostomy aeb [evidence]