Primary Nursing Diagnosis: Stable Patient?

[Scythinian]

Hello all! First time poster because I need some help figuring out a primary nursing diagnosis for a postpartum patient who, despite crawling through a chart and noting every detail, has no issues which I can specifically pin down. My assignment is to develop three diagnoses, one of which is the primary that we develop a complete plan of care for. This is where I've got some trouble.

Pertinent info

Severe obesity both ante and postpartum (BMI 38+)

Type 1 insulin diabetic

+2 pitting edema, bilateral

Save for those three conditions the delivery was a textbook planned c-section (term), patient displays adequate knowledge of and access to resources for postpartum care of self and infant, and no history of mental illnesses that would suggest need for further assessment. Diabetes was managed to a T via insulin injections throughout pregnancy.

I was thinking something revolving around imbalanced nutrition requirements (excess) or something specific to her diabetes but for the life of me I can't find a list of nursing diagnoses specific to diabetes.

Any help would be greatly appreciated!

[stu720]

can you use imbalanced nutrition more than body requirement

[Scythinian]

Absolutely. My clinical instructor is pretty strict on expectations and with all the data I have I'm afraid I'm missing what would be the priority above all. Imbalanced nutrition is what I was leaning towards to begin with since it covers all of her current concerns.

[Mike R, ADN, BSN, RN]

Were you actually able to do a physical assessment on her, or just through the charts? I can think of a hand full of NANDAs just off of what you listed.

Imbalanced nutrition, sure. What's stopping you from looking further into the pitting edema? The diabetes is more of a "risk for", but it's there. What about the giant incision on her belly? Also, despite of the opinion that you think she has adequate knowledge and access to self care and infant, there is ALWAYS a knowledge deficit of SOMETHING :)

[NCRNMDM, ASN, RN]

How do you explain the pitting edema? Delve further into that, and you may find some diagnoses there. Also, you could do nutrition greater than body requirements, and you could do a risk for diagnosis related to diabetes. If you have a careplan book, go through it and see if there are any diagnoses that fit your patient and make sense given the information you have.

[Scythinian]

Were you actually able to do a physical assessment on her, or just through the charts? I can think of a hand full of NANDAs just off of what you listed.

Imbalanced nutrition, sure. What's stopping you from looking further into the pitting edema? The diabetes is more of a "risk for", but it's there. What about the giant incision on her belly? Also, despite of the opinion that you think she has adequate knowledge and access to self care and infant, there is ALWAYS a knowledge deficit of SOMETHING :)

The pitting edema seems to be related strictly to the pregnancy. Considering the patient had delivered just shy of 8 hours before I arrived the edema doesn't seem abnormal. Her labs showed that only her WBC was slightly elevated (21.6k/mm^3). You may be onto something with the deficit knowledge part: her husband is a nursing student and father a doctor. Maybe she was coached to know the right things to say and is only parroting without the actual understanding of what it all means?

How do you explain the pitting edema? Delve further into that, and you may find some diagnoses there. Also, you could do nutrition greater than body requirements, and you could do a risk for diagnosis related to diabetes. If you have a careplan book, go through it and see if there are any diagnoses that fit your patient and make sense given the information you have.

My care plan book and my little nursing diagnosis books are focused more towards the generic med surg or psychiatric patient with a scant bit on the maternal and infant aspect of things. When it comes to the diabetes what risk would you suggest looking at? Because she has a history of having her glucose so well controlled for the life of me I can't think of a risk. Perhaps risk for impaired wound healing? Glucose stores being depleted thanks to surgery, stress from delivery, disliking hospital food could all sensibly contribute to the impairment of the healing process I think.

I appreciate the help! Keep it coming if you've got an idea! My assignment isn't due for another couple days so I have time to tinker and mull things over.

[nurseprnRN, BSN, RN]

first baby? breastfeeding or not? knowledge of infant care? got a pediatrician/pedi nurse practitioner? how's her dm gonna work when she's stressed by being awake at night? lots of things to learn there. many family-centered nursing assessments and interventions, too-- remember, the family is your patient in this setting. look at dm, sure, but step back a bit and see the rest of the forest.

[Scythinian]

first baby? breastfeeding or not? knowledge of infant care? got a pediatrician/pedi nurse practitioner? how's her dm gonna work when she's stressed by being awake at night? lots of things to learn there. many family-centered nursing assessments and interventions, too-- remember, the family is your patient in this setting. look at dm, sure, but step back a bit and see the rest of the forest.

second baby (first child now ~8)

breastfeeding--first was breastfed also

knowledge of infant care seemed adequate when i interviewed her. patient mentioned reading a few books "as a refresher" plus a family planning class before the delivery.

i think that's where i'm hung up in all this. i'm trying to focus on the actual mom rather than the entire dynamic that was just created with the addition of a new baby. oh! light bulb! interrupted family process! caregiver role strain! full time nursing student husband, maternity leave, recently moved to the area. those are all pretty big considerations now that i think about it.

[CT Pixie, BSN, RN]

What stood out to me is the DM and the incision from the C-section. Huge huge risk for infection and poor healing.

[Mike R, ADN, BSN, RN]

The pitting edema seems to be related strictly to the pregnancy. Considering the patient had delivered just shy of 8 hours before I arrived the edema doesn't seem abnormal......

I think you're missing the point. Post partum or not, there's still excess fluid volume. You're hung up on whats normal for a baby process. But baby process isn't mom's normal state.

[HollyGoLightlyRN]

All post partum mom's are at risk for hemmorhage, risk for infection, pain, interrupted family process, deficient knowledge: breastfeeding etc. Her c-section status adds Impaired Skin Integrity...great patient to write a care plan on.