cheath38

Thank you for the suggestions. I know it may appear like I'm trying to make my patient "fit" a certain diagnosis, I have carefully collected data regarding all levels of functioning, and all body systems. It was just that when writing the care plan, the main turn of events and second most critical body systems that had acute changes was renal. After analyzing all my data, labs values, patient symptoms (including large fluid input, thirst, dehydration, yet minimal, concentrated output) the possibly nephrotoxic treatment regime for pneumonia and copd, acid/base balance, and several other factors that "painted a picture" I have decided to use the NANDA Risk for Impaired Renal profusion. The reason I felt I needed a "NANDA" to help "guide" my interventions, is because my instructor looks for the goals/interventions to closely follow and strictly adhere to the information given under a specific diagnosis. The interventions (in real clinical/nursing practice) are in fact steps that would be taken, but of course, tailored to my patient. Its just hard when you have a picture of what is happening, and are "REQUIRED" to stay within parameters for a very specific nanda. I know everyone says to collect data (assessment) first, and I did that...but the suggestion to go into goals and interventions without establishing a set NANDA is contradictory the method of writing care plans that I was taught. I can use clinical reasoning and logic to make my own interventions/goals, but my instructor checks to see if they are EVIDENCE based SPECIFICALLY for a certain nanda. So, as I am pressed for time, it would be counter-intuitive and possibly a waste of time to form my whole detailed care plan, then try and attach a NANDA that fit my patient's goals/nursing interventions...or have to change all the steps I outlined. Does that make any sense? I agree, the rigidity of how the care plans are reviewed and graded, can make it feel like I am just trying to "make symptoms fit" a generic care plan (and that is the opposite of individualized, patient centered practice) But, I try to find a balance between "care plan expectations" and holistic care of my patients while I am a student.

Hi, First of all, thanks for the response. I just joined this site, and I'm still learning how to communicate on here. I do have my NANDA book as my general guide for writing care plans, but I've never had a patient with acute renal complications. We profiled a patient last week to write an assessment on and do a two part care plan. The main medical diagnosis was community acquired pneumonia, and my first diagnosis is "Ineffective Breathing Pattern". Without breaking down her entire hospital stay and medical background, suffice to say, she developed renal issues as a result of vancomycin treatment. She was early sixties, normal weight, minor newly diagnosed hypertension, no other chronic health issues. But after days of IV antibiotics, which resulted in diarrhea, and several tests using contrast dye since admission..she is having the above listed renal issues. Specifically, her lab values were off/high and she was drinking tons of water and barely urinating. She did not have edema. My instructor agreed after seeing her high vanco trough reading that she was indeed having renal issues, but when I listed several "urinary" nandas, we both agreed they didn't quite fit. I have limited experience with nandas, and because the findings are so new, I am hesitant to list "acute renal failure" and the accompany nanda for that. Any guidance here??

Is there a nursing diagnosis for acute nephrotoxicity related vancomycin trough being extremely high, client dehydration, high protein, amorphorous crystals, oliguria, and increased BUN and Cr readings?