Care Plan Help Please!

[Nurse2bNicole, BSN, RN]

Hi all - I'm working on a newborn care plan and I'm trying to find a diagnosis to fit with elimination. Baby has a hydrocele and a skin septum attaching his member to the scrotum. All of the risk for altered elimination diagnoses that I'm finding seem to only apply to adult patients! BTW - baby had not voided as of 6 hours of age, however when Peds did their assessement and pressed on his bladder urine would leak out. At this time we weren't sure if he was going to void on his own.

[Daytonite, BSN, RN]

so, the baby has urinary retention? there is a nursing diagnosis for this problem: urinary retention

• definition: incomplete emptying of the bladder
  
• related factors: blockage, high urethral pressure caused by weak detrusor, inhibition of reflex arc, strong sphincter
  
• defining characteristics: bladder distention, small frequent voiding or absence of urine output, dribbling, dysuria, overflow incontinence, residual urine, sensation of bladder fullness
  
• (nursing diagnoses: definitions & classification 2005-2006 published by nanda international, page 213)

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=57

[color=#3366ff]http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_074.php

there is also another nursing diagnosis, impaired urinary elimination, but your patient's symptoms do not fit this diagnosis.

[discobunni]

I'm a student too...so don't know if this would be correct. But I am leaning toward

Urinary retention r/t absence of urine output secondary to open processus lady partslis aeb urine leakage w/bladder palpation and (palpable scrotal bulge ???).

(I am just assuming this is what you have assessed based on the info you've provided)

I'm sure the RN's are going to ask you for more detailed info to get a more accurate diagnosis.

Do you have a good NANDA book?

I'm looking forward to see what the RN's would say about this one.

[discobunni]

OH...Daytonite beat me already!! LOL

[Nurse2bNicole, BSN, RN]

Thank You!! I wasn't sure if urinary retention would work because the baby was still

[Daytonite, BSN, RN]

nurse2bnicole. . .i don't know where you've gotten the idea that there might be nursing diagnoses that only apply to adults or children! nursing diagnoses are merely clusterings of patient "problems". patient "problems" are the result of what you find to be abnormal symptoms during the data collection process. that applies to all patients from age birth to 99 years of age.

if you have a care plan book or a nursing diagnosis book, read the very first chapter(s) that talk about the nursing process and how it pertains to the writing of care plans. sometimes it takes more than one reading because the information is so heavy. however, in a nutshell what goes into the determination and formulation of nursing diagnoses and the three-part nursing diagnostic statement is this:

problem--etiology--symptoms

this comes from the first two steps of the nursing process. step #1 is assessment where you glean information from the patient's written records, interviews and your own physical assessment. all information you can gather counts. in step #2 you take that assessment information and pull out the abnormal data, or symptoms. this is why it is so important to know what a normal physical exam is, what normal lab values are, etc. so, when you see an abnormal something-or-other you catch it and pick up on it. you take your list of abnormal symptoms and go shopping for a nursing diagnosis. each nursing diagnosis has both symptoms (nanda calls them defining characteristics) and etiologies (nanda calls them related factors). a book like nursing diagnoses: definitions & classification 2005-2006 published by nanda international has all of this information listed in it and only costs $25 (you can purchase them directly from nanda). you can also get the very same information in other care plan and nursing diagnosis books such as nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig which also is greatly expanded to include nursing interventions, outcomes and has a cross reference of signs, symptoms and conditions which makes it a little easier for a newbie at care plans because it points you in the direction of nursing diagnoses to look at when patients have certain medical conditions. it runs about $40 or so.

prior to nursing diagnoses, we wrote care plans by just listing patient's abnormal symptoms (or problems) and addressing each one individually. what nanda did was group, or they use the term "cluster", some abnormal symptoms and became the authority that said "ok. from now on this is what we're gonna do. these symptoms belong together because they are related to the same etiologies. so we're going to call them nursing diagnoses." the idea is that it sounds more professional. there are also other motives for this being done, but this is not the forum to discuss this.

just like doctors learn to put medical diagnoses with diseases, you are learning to put nursing diagnoses with patient problems and behaviors. each nursing diagnosis has a definition, causes and symptoms for it. there is not much guessing to this. there is some room for give and take and perhaps a little imprecision with them because they often address behavior rather than some things that can be measured empirically and the fact that we are reducing behavior to words that express it as factually as we can. that, however, is one of the great difficulties of working in the behavioral sciences.

to get back to the problem you have with your little patient. . .the problem at hand was urinary retention based on your assessment information. and, there is a nursing diagnosis for that, age aside. i quoted all the information pertaining to it's related factors and defining characteristics directly from my nanda resource for you.

[Nurse2bNicole, BSN, RN]

Thank you Daytonite! I'm not really sure why my brain thinks that there are different diagnoses for adults and children. I guess I was expecting there to be an obvious way to relate the diagnosis to the newborn age because some of the diagnoses have a specific maturational component that lists transition to extrauterine life as the r/t. I don't know....I think my brain is fried at this point!