Hello again, I'm doing my POC for this week and having some trouble finding a ND. To start, this patient is a 47 year old female admitted for a total abd hysterectomy, with chronic blood loss due to uterine fibroids. Her symptoms are pelvic pain, urinary frequency, constipation, and painful intercourse. She has been taking Lupron Depot for 6 months with no success. She is also anemic and taking ferrous sulfate. Other symptoms due to this are weakness, fatigue, and pallor. She has a history of upper respiratory tract infections, but no other medical problems. Vitals signs are BP 132/82, T 98.5, pulse 74, resp 14. O2 sat 99%/ Heart sounds audible S1 and S2, peripheral pulses 3+ bilaterally (radial, and pedal), bowel sounds audible in all 4 quadrants, abdomen distended and firm, foley catheter draining clear yellow urine, IV of D5 1/2 NS running at 100 ml/hr.
Since she is anemic I want to include that in my top 3 ND, but I'm having a hard time figuring out where to go with that. Should I be using Imbalanced nutrition less than body requirements? Is there any other diagnoses I can use for this? I am looking in my ND book, but not having much luck.
I know pain will be a ND, because she is already in pain and will more than likely be in pain after surgery. I have a lot of "risk for" diagnoses listed on my POC already, such as risk for constipation, risk for infection, risk for ineffective airway clearance, and also fatigue and activity intolerance.
I will be buying a Care plan bk. next week and hopefully that will reduce the amount of stupid questions I post on here. But until then thanks to all of you who are willing to help.
Oh ok, I had not heard of those, probably because they want us to focus on the NDs. But anyhow, electrolytes are fine. What about Chronic pain rt uterine fibroids AEB reported pelvic pain? We aren't supposed to use medical Dx for our rt, but I can't think of anything else and the book doesn't offer much help.
If she had a TAH then she wont have fibroids anymore and her pain is probably now acute..so I gave you 3 above..I used to google care plans in my 1st and 2nd semesters like search amenia care plans...might give yoy more ideas..or TAH care plans. .
Your related to will be the pathophysiology of the problem...work the nursing diagnosis backwards. ..start with the secondary to (medical diagnosis) then break that down into the patho.(r/t).which then points you to the ND
This is a lab simulation and I think they want us to assume she hasn't had surgery yet. But I see what you're saying. I tried googling care plans for anemia and found Activity intolerance related to imbalance between oxygen supply and demand as the primary focus
Gotcha! Thank you so much! I don't know what I would do without some help. This is always harder than I think it will be. But I'm glad I'm getting somewhere with it.
Looking at my ND book and a little online, the defining characteristics for decreased cardiac output match the symptoms better than ineffective peripheral tissue perfusion. Eg: under decreased cardiac output rt decreased preload associated with hypovolemia
it has pallor, weakness, and fatigue / under ineffective peripheral tissue perfusion it has paresthesia, diminished pulses, edema.
I think I'm confusing myself. I know that if she has anemia her heart is going to work harder, which will lead to high bp, and heart rate but low cardiac output, which could then cause ineffective peripheral tissue perfusion due to decreased flow to the tissues. But decreased cardiac output comes after the heart enlarges and fails to compensate right? (excuse my terrible english) And I know that ineffective peripheral tissue perfusion can exist without cardiac output decrease, which could be completely possible with her. Her symptoms just match decreased cardiac output better. I guess I'm just confused, because my symptoms are not matching up and I don't know which one of these is the real problem. I'm so sorry if I'm making no sense.
THE only data u have to back up CO IS PALLOR FATIGUE, AND recent blood loss. Plus labs are ok except hh ....remember. ..HR, contractility, preload(volume), and afterload(svr) affect CO. HR is fine, bp is fine..what values reflect preload? Hard to meadure contractility without a Echo
You're right. I was having a hard time seeing that yesterday only because of the defining characteristics. There is definitely no evidence of that being an actual problem yet. Which is why you suggested the other. Thank you for the help.
Decreased cardiac output is not indicated by her assessment data. Indeed, many people with severe anemia have increased CO as their bodies try hard to deliver more oxygen. >>> "Other symptoms due to this are weakness, fatigue, and pallor."
How do you think she feels with insufficient oxygen delivery to her tissues? Remember, someone with an O2 sat of 99% and a crit of 20 is carrying one half the amount of oxygen as someone with a sat of 99% and a crit of 40. Sats don't tell the whole story, there, do they?
What would nursing do for someone like this, independent of medical plan of care?
Oh ok, I had not heard of those, probably because they want us to focus on the NDs. But anyhow, electrolytes are fine. What about Chronic pain rt uterine fibroids AEB reported pelvic pain? We aren't supposed to use medical Dx for our rt, but I can't think of anything else and the book doesn't offer much help.
Do you not have a NANDA-I 2012-2014? Chronic pain as a nursing diagnosis has very specific defining characteristics and related factors. Does she meet them?
A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."
"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological."
If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don't care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from Amazon. When you get it out of the box, first put little sticky tabs on the sections:
10, life principles (hope, spiritual, decisional conflict, nonadherence...)
11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)
12, comfort (physical, environmental, social...)
13, growth and development (disproportionate, delayed...)
Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. If not... keep looking. Eventually you will find it easier to do it the other way
To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!
mlauren
107 Posts
Oh ok, I had not heard of those, probably because they want us to focus on the NDs. But anyhow, electrolytes are fine. What about Chronic pain rt uterine fibroids AEB reported pelvic pain? We aren't supposed to use medical Dx for our rt, but I can't think of anything else and the book doesn't offer much help.