Nursing Interventions for Care Plan

i get the concern you feel for this patient and i think that is admirable. however, you are writing a care plan that is going to be turned in for a grade, no? so, there are some things you have to adhere to in completing this assignment.

first of all, the way you have worded your nursing diagnosis is not the way they are usually done. nanda-i (north american nursing diagnosis association, international) guidelines do not allow nurses to use medical diagnoses in the nursing diagnostic statement unless this is something your instructors have told you that you could specifically do. also, nanda-i words this particular diagnosis differently. for this patient you need to state why (the cause) there is risk for imbalanced nutrition: more than body requirements. this is based on your best analysis and the assessment you made of her. the definition of this particular nursing diagnosis is that the person is at risk of eating more than their body needs. however, i'm also wondering if perhaps there is another nursing diagnosis you might want to consider here: risk for noncompliance. using the nursing diagnosis you have suggested, your nursing diagnostic statement should be worded more correctly like this:

• risk for imbalanced nutrition: more than body requirements r/t [these are some of the nanda-i suggestions for risk factors that go with this nursing diagnosis: concentrating food intake at the end of the day, reported or observed obesity in one or both parents, pairing food with other activities, observed use of food as reward or comfort measure, eating in response to internal cues other than hunger, eating in response to external cues, dysfunctional eating patterns--nursing diagnoses: definitions & classification 2005-2006 published by nanda international, page 129]

notice there is no mention of the patient's medical diagnoses in the nursing diagnostic statement.

let me list the defining characteristics (these would serve as the risk factors) for a nursing diagnosis of risk for noncompliance:

• behavior indicative of failure to adhere (by direct observation or by statements of patient or significant others)
  
• evidence of development of complications
  
• evidence of exacerbation of symptoms
  
• failure to keep appointments
  
• failure to progress
  
• objective tests
  
• nursing diagnoses: definitions & classification 2005-2006 published by nanda international, page 124

you can find nursing interventions for both of these diagnoses at these webpages:

• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=38 imbalanced nutrition: more than body requirements
  
• [color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_050.php imbalanced nutrition: more than body requirements
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=36 noncompliance

if you are going to be writing care plans for school it would probably be very beneficial for you to invest in a good care plan or nursing diagnosis book. the nursing intervention sites i've listed for you above come from companion websites that go with these two particular books:

1. nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig.
   
2. nursing care plans: nursing diagnosis and intervention, 6th edition, by meg gulanick and judith l. myers.

the problem with depending on the websites for your information, however, is that these sites do not have the complete text that is in their books. the ackley/ladwig site only has 75 nursing diagnoses on it. the gulanick/myers site has even less, a little more than 50. there are a total of 172 nursing diagnoses that nanda-i has approved for use. i have copies of both books i've listed above. both are good. both run about $40, give or take a few bucks. both books list nursing interventions with each nursing diagnosis. the ackley/ladwig book has a very good explanation in the first chapter on how to determine a nursing diagnosis. it also has an index where you can get a list of potential nursing diagnoses based on the signs, symptoms, conditions and medical diagnoses a patient has. while the gulanick/myers book is very good, the ackley/ladwig book is by far the best seller and one most recommended by students and instructors.

i hope your patient does well. we can only do our best to share information with them before their discharge. what a person does once they get back to their own home, however, is their choice. all we can do is be supportive when patient's are ready to listen and do our best to give them information. good luck with this care plan!