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Pt doesn't know has cancer, nursing dx help

Posted

I had a pt that was unaware of her cancer diagnosis due to family's wishes. This being a huge ethical issue, I am trying to come up with a dx related to this.

Ineffective coping came to mind, but that doesn't seems right since she doesn't know her diagnosis.

In my nursing dx book there was a dx of Powerlessness, which seems appropriate because the pt cannot speak English and the family will not translate cancer to her. Powerlessness r/t unknown medical diagnosis?

Comprimised family coping r/t patient's unknown dx?

I'm having a hard time figuring out how to word the dx, as well as if I should even go this way or try something else, such as pain r/t disease processes.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

You are trying to fit this patient/family into a diagnosis. Why are they not tell the patient the diagnosis? Are they in denial themselves? What behaviors/characteristics does the family exhibit that fit the definition of your diagnosis. How is this effecting the patient? Just because it is an ethical dilemma doesn't mean it will fit into the care plan. What care plan book do you have? You are first semester right? OK.

Care plans are all about the assessment of the patient. What the patient needs.....

For example: Ineffective coping..... NANDA defines this as the:

Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources.....does the family patient/family exhibit any of these behaviors?

Defining Characteristics

Change in usual communication patterns; decreased use of social support; destructive behavior toward others; destructive behavior toward self; difficulty organizing information; fatigue; high illness rate; inability to attend to information; inability to meet basic needs; inability to meet role expectations; inadequate problem solving; lack of goal-directed behavior; lack of resolution of problem; poor concentration; reports inability to ask for help; reports inability to cope; risk taking; sleep pattern disturbance; substance abuse; use of forms of coping that impede adaptive behavior

Related Factors (r/t) Disturbance in pattern of appraisal of threat; disturbance in pattern of tension release; gender differences in coping strategies; high degree of threat; inability to conserve adaptive energies; inadequate level of confidence in ability to cope; inadequate level of perception of control; inadequate opportunity to prepare for stressor; inadequate resources available; inadequate social support created by characteristics of relationships; maturational crisis; situational crisis; uncertainty

Is your care plan supposed to be based on the highest priority of needs first? Is the a priority need for the patient? You are picking the diagnosis and fitting the patient into the situation. While it is important to know that the patient is clueless about the diagnosis is that information necessary/important to the patients immediate physical needs? Thiose physical needs need to be cared for first before you take on therapy for the family.

What care plan book do you use? Do you have the supporting evidence from your assessment that supports this diagnosis? I use Ackley: Nursing Diagnosis Handbook, 9th Edition and Gulanick: Nursing Care Plans, 7th Edition.

Simply put.......Care plans are the recipe card on how to care for someone....logically, rationally. They tell you what is important for any particular patient....and what needs to be looked at, treated, considered first. Care plans as a nurse is a standard recipe card .....you already "know" how to bloom yeast.....as a student you look up, include the how to, and "learn" how to bloom the yeast so you can remember the how to for the future.

Care plans are all about the assessment OF THE PATIENT.....the whole patient. What is the patient assessment? What do they need? Have they had any procedures? What brought them to the hospital? How long have they been hospitalized? What are their vitals signs? What is their main complaint? Tell me about your patient!

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

ADPIE

  1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
  3. Planning (write measurable goals/outcomes and nursing interventions)
  4. Implementation (initiate the care plan)
  5. Evaluation (determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

These sheets may help you out.....daytonite made them (rip)

critical thinking flow sheet for nursing students

student clinical report sheet for one patient

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1. Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Now tell me about your patient....what do they NEED!

^^^Familys can have nursing diagnosis too:)...not just the patient

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

^^^Familys can have nursing diagnosis too:)...not just the patient

very true, and it should be included, but should that be the first, or only, considered on an initial care plan in caring for this patient? Sure if there are no pressing medical symptoms like pain that need to be addressed.

Okay I think that I should go with more of a priority dx, such as pain. I was really just having a problem with not addressing that particular issue because it seemed so wrong to me that she had no idea she had cancer and what the overall outcome was, the fact that she was going to die so soon without knowing. But I understand that this may not be the priority now. Thanks for all the help.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

ethically it stinks....but is not knowing a priority for this patient right now to help her feel better.

drowningdaily

Has 6 years experience.

It may feel unethical to you. But, in some cultures this is common practice. Many people do not want to know there diagnosis. So, if this is the case, you are advocating for your patient by honoring her and her family's practices.