Daytonite

for the mother: effective breastfeeding for the baby: effective breastfeeding ineffective thermoregulation r/t immature compensation for changes in environmental temperature risk for infection r/t break in skin integrity at umbilical cord site

I receive chemotherapy and one of my drugs causes the same problem with my feet as well as my hands. I do have to use a walker on the days that my feet as swollen and sore. Your diagnosis: Impaired tissue integrity r/t chemical insult, secondary to chemotherapy side effects or r/t cell lysis secondary to chemotherapy aeb feets bilaterally hot and tender to touch, nonpitting edema tender to touch, protectiveness toward site, thrombocytopenia, and reported local and intermittent pain upon palpation of reddened areas Is actually OK. I would clean up the wording a little bit as follows: Impaired tissue integrity r/t chemotherapy aeb bilateral feet hot and tender to touch as well as edematous, skin reddened, shiny and taunt over feet and joints, intermittent pain upon palpation of areas of feet and patient protectiveness of the feet. I would not use thrombocytopenia as a symptom of impaired tissue integrity. nutritional deficiency r/t malabsorption and decreased intake secondary to treatment side effects aeb reported loss of the sense of smell and reported loss of the sense of taste. I have runs where I don't feel like eating and then other days where I can eat like a horse. However, nutritional deficiency is not a nanda diagnosis. I would re-write this as imbalanced nutrition: less than body requirements r/t decreased intake secondary to chemotherapy aeb patient report of loss of sense of small and taste. Impaired urinary elimination r/t kidney damage secondary to multiple myeloma and chemotherapy aeb reported daily use of diuretics and pt reporting need to rush to bathroom to avoid incontinent episodes. Use of daily diuretics is a medical treatment and not a symptom of the nursing problem so you shouldn't be using it as an aeb item. The patient's frequency (rushing to the bathroom) is the symptom of the impaired urinary elimination. I would re-write this as: impaired urinary elimination r/t kidney damage secondary to multiple myeloma and chemotherapy aeb patient reports of needing to rush to bathroom to avoid incontinence. social isolation r/t avoidance of crowds secondary to chemotherapy-induced immunosuppression aeb reported avoidance of crowds and h/o neutropenic isolation. This could be improved. First of all, avoidance of crowds is not a cause for social isolation. The definition of this diagnosis is aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state. Your related factor (r/t), or cause, of the social isolation must explain to the reader why they prefer to experience aloneness and avoidance of crowds secondary to chemotherapy-induced immunosuppression doesn't do that. Your one symptom of the isolation, the reported avoidance of crowds, is OK, but a h/o neutropenic isolation makes no sense. that sounds more like something someone would be fearful of. his illness alone and the way he might perceive what he looks like is enough aeb evidence for a social isolation diagnosis. you might try wording the diagnosis this way: social isolation r/t altered state of health aeb refusal to join in any group activities or go out into the public. - - - - - - - - - - - - - - - The construction of the 3-part diagnostic statement follows this format: Problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information. Etiology - also called the related factor by nanda. this is what is causing the problem. it is the reason the problem exists and reasons can be many and varied. ask yourself "why did this happen?" or "how did this problem come about?" "what caused this to become a problem in the first place?" and dig deep. consider the medical diagnosis, the medical treatments that were ordered and the patient's ability to perform their adls. pathophysiologies need to be examined to find these etiologies if they are of a physiologic origin. it is considered unprofessional to list a medical diagnosis, so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this. Symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they can also be the same signs and symptoms of the medical disease the patient has, the patient's responses to their disease, and problems accomplishing their adls. they are evidence that prove the existence of the nursing problem. if you are unsure that a symptom belongs with a nursing problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.

Good diagnoses, but before making any goals, consider what nursing interventions you will order. The reason I recommend this is because your goals are what you expect to happen as a result of the nursing interventions being performed.

Impaired Verbal Communication.

A "risk for" diagnosis almost never is sequenced first because it is not an actual problem. actual problems are always sequenced before potential problems. second, poor tissue perfusion is not an official nanda diagnosis and i have no idea what you mean by it. poor tissue perfusion of what tissues? the diagnosis of decreased cardiac output covers the poor tissue perfusion of the heart. the edema is evidence of that. third, if the patient is actively bleeding and hypovolemic then there is no risk for fluid volume deficit. there is already deficient fluid volume [decreased intravascular, interstitial, and/or intracellular fluid. this refers to dehydration, water loss alone without change in sodium. (page 84, nanda international nursing diagnoses: definitions and classifications 2009-2011)] if the symptoms are there. the evidence (assessment information) you have of the deficient fluid volume is the tachycardia, decreased urine output and hypotension. someone who has active gi bleeding would be pale and weak. when they try to get up they become diaphoretic and tachycardic and sometimes need help to get back to bed. they have low hemoglobin and hematocrit levels. if this patient had those symptoms then deficient fluid volume would be the diagnosis to use. this would be sequenced after decreased cardiac output. please look at this thread for information on the construction of a care plan using the nursing process and how to determine diagnoses: https://allnurses.com/general-nursing-student/help-care-plans-286986.html- help with care plans

Do not mix interventions or goals for the mom with the neonate if the care plan is for the neonate.

Because continuous bubbling means there is a leak in the system and therefore the chest tube is not able to do its job. Yes, it is supposed to bubble, but only on expiration when the lung is releasing air from the pleural space.

Your goals reflect what your interventions would be, so what are your interventions?

The problem is that the care plan is about the mother. You can't mix up mother and baby problems on one care plan.

you posted this on the nursing student discussion forum and i just got finished replying to it. you need to go over there to read the answer. https://allnurses.com/general-nursing-student/confused-about-this-457358.html - confused about this??

no. you would know that from knowing the course of the disease. you would know that it created the nerve damage and that is why the patient is having pain. the definition of chronic pain is unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (international association for the study of pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without an anticipated or predictable end and a duration of more than 6 months. (page 355, nanda international nursing diagnoses: definitions and classifications 2009-2011). so placing the kind of damage as the related factor on the nursing diagnostic statement is perfectly acceptable.

an l&d care plan is no different from a med/surg care plan. you still go through the same process for determining the nursing problems. you are just dealing with a different set of data that involves the gynecological system and the birthing process. the first thing you need to do is assess that patient. you also need to know the birthing process and its pathophysiology just as you do for any other medical disease or condition. the only information you've provided in this post is all about the patient's medical conditions. we are nurses. we deal with how the patient responds and reacts to what is happening to them. so, when you assess the patient you think about what you know about the birthing process and what it does to the patient's body. think about what happens to the birth canal as a baby comes through it. does damage to the tissues occur? is that where some of the pain comes from? what happens when tissues are damaged? the inflammatory response sets in: redness, heat, swelling and pain. just because it is internal and you can't see it doesn't mean that it isn't happening. this is not different from a med/surg patient that comes in with some kind of physical trauma except we call it part of the normal birthing process. what else happens to the woman's body when that baby comes through the birth canal? how does it affect the bladder and the orifice? is she breastfeeding? there are 3 nursing diagnoses that involve breastfeeding whether things or going well or not. if you want to address the patient's substance abuse problem you care plan for it just as you would for a med/surg patient, but is it affecting the labor and delivery process? i get that you "feel" it needs addressing, but care planning and the nursing process is scientific and you have to address the evidence in front of you. if there is no evidence of a problem now, then leave it alone. you cannot begin to write nursing interventions until you have gone through your assessment data and found the abnormal data that is going to be the evidence of the nursing diagnoses you end up with. you will do nursing interventions for the symptoms of each nursing diagnosis. - - - - - - - - - - - - - - - acute pain r/t pitocin induced labor process you cannot use a medical treatment as the cause of her pain here. her pain is due to the contractions she is having or the afterbirth pain. did she have an episiotomy. that can be a cause of pain as well. risk for maternal/fetal injury r/t obstetrical complications you need to be able to actually list what procedures she had that are putting her at risk for injury. also, i would not include fetal injury with the diagnosis because this care plan is about the mother and not the fetus. potential for post partum hemorrrhage r/t cervical or lady partsl laceration or hypotonic uterus this is not an official nanda diagnosis. hemorrhage is a medical decision so you really can't use it in a nursing diagnosis. what you can use is risk for bleeding.

see this thread for information on how to construct a care plan: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans. all care planning begins with listing out your assessment information, not trying to diagnose the nursing problems first. the nursing problems (what everyone wants to call nursing diagnoses) are based on the abnormal assessment data that we see and observe in the patient. that data is evidence and symptoms of each nursing diagnosis that gets chosen. why or how you came up with something like dysfunctional ventilatory weaning response is kind of impressive, but it usually is used when there are a lot of problems getting the patient weaned off a ventilator. while breathing problems are symptoms of this diagnosis, using accessory muscles when breathing is a symptom of another nursing diagnoses: ineffective breathing pattern. dysfunctional ventilatory weaning response is primarily about how the patient is handling oxygen and their responses to that. you need to look at other assessment information like the patient's lung sounds, if they are coughing and their abgs. there are other respiratory diagnoses that will probably be better to consider for this patient. your nursing interventions then target the symptoms of the nursing problems the patient has.

I assume the patient had shingles at one time. Isn't the neuralgia because of nerve damage? Did you read up on the pathophysiology of this? That would make the diagnosis Chronic pain R/T nerve damage AEB [evidence of patient's pain]. All you have is subjective evidence of the patient's pain. Don't you have more objective symptoms?

i see that you are a new poster on allnurses and that you already posted about this on the nursing student discussion forum. there is a thread that explains how to write care plans that you should be reviewing where the care planning process is gone over and there are many examples of how its done: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans. the care planning process is done by the nursing process. why? because care planning is problem solving and the nursing process is the tool for problem solving that we use. if you follow the steps in sequence you will get to your final destination--solving the patient's problem(s). first of all i want you to realize that diagnosing is done in many different disciplines. doctors, car mechanics, plumbers. diagnosis is just a fancy word for saying you are determining what the problem is. but all jobs that engage in fixing problems do pretty much the same process to get to finding the problem and solving it. the difference is that each one has a unique set of information that they have to deal with. we have to know about medical diseases and nursing care. step 1 assessment - assessment consists of: a health history (review of systems) - 80 year old female with atrial fibrillation and chronic pulmonary embolism. she has a history of falling a month ago because of being weak and dizzy and sustaining a concussion. performing a physical exam - the only physical exam information provided is that she is weak, dizzy and confused. no heart sounds, lung sounds provided. assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) - no information provided reviewing the pathophysiology, signs and symptoms and complications of their medical condition - each medical condition should be looked up and textbook symptoms compared with the patient's symptoms to see if you missed seeing any them. also the pathophysiology of the conditions is needed to help you determine the etiology ("related to") parts of your nursing diagnostic statements http://www.merck.com/mmpe/sec07/ch075/ch075e.html - atrial fibrillation http://www.merck.com/mmpe/sec05/ch050/ch050a.html - pulmonary embolism [*]reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - none provided. these can give you clues as to other conditions that the patient has as well as to potential problems that side effects of the medications might be causing. step #2 determination of the patient's problem(s)/nursing diagnosis - this is where you need to sort through the assessment data and separate out what is normal and abnormal. abnormal data is the evidence of problems. the only real evidence that you have provided is that the patient is weak, dizzy and confused and i am sorry to tell you that these are not symptoms (according to nanda) of decreased cardiac output. symptoms of atrial fib are dyspnea, dizziness, palpitations. someone with pulmonary embolism will generally have tachycardia along with weak and rapid pulses and hypotension (this is evidence of decreased cardiac output), low grade fevers, and possible a productive cough that may be blood tinged (ineffective airway clearance). however, your assessment information doesn't report any of that. weakness is evidence of something like fatigue, confusion is evidence of acute or chronic confusion and dizziness would be concern for risk for injury which are all nursing diagnoses. this patient also warrants a diagnosis of risk for falls because of her prior history of falling and her age. step #3 planning (write measurable goals/outcomes and nursing interventions) - this part of the care plan is based on the abnormal assessment data that you obtained. just as a doctor treats the symptoms of a disease we nurses also treat the symptoms of a nursing problem. if a patient has acute confusion and the symptoms are they hallucinate or do not know place or time, your nursing interventions are to do something about those. your goals are what you anticipate will occur as a result of your nursing interventions being performed. you need to review your assessment data because it is not complete. - - - - - - - - - - - - - - decreased cardiac output r/t a-fib amb dizziness, weakness and confusion. the related factor of a nursing diagnostic statement cannot be a medical diagnosis. it must be the cause of the decreased cardiac output in more generic terminology. this is why you must know the pathophysiology of atrial fib and what actually causes it. the related factor is what is causing the nursing problem. a nursing diagnosis reference will give you suggestions for related factors for this diagnosis, but they are very broad based. as i said above weakness and confusion are not manifestations (symptoms) of decreased cardiac output. dizziness may be if you get the correct related factor for this diagnosis.