Question about Nanda dx

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I am a foundation student trying to work with a "Risk for loneliness r/t affectional deprivation, social isolation." dx. Here are my supporting data:

Stated, "...I like to nap a lot, it makes the day go by faster."

Has been in a room in bed for almost 2 months.

Regarding his girlfriend, stated, "She can't visit, she is in a nursing home and health wise worse off than I am."

Children, grand kids and girlfriend all live in [in a town more than 1 hour away].

Stated "I'm really shy, but the more we talk, the more I open up"

Expressed uncomfortable feelings regarding when "people speak down to me. I'm 6'1", I'm not used to it, I'm usually the one looking down while standing in conversation. I feel anxious sometimes."

My book is giving me some outcomes that doesn't really help, like will participate in social activities, will maintain at least one relationship, will use time positively when alone and socialization is not possible.

This man has been alone in a room in bed for almost 2 months, talked about his family but never mentioned if they visited, sleeps all day, requests his door be kept shut all the time, and keeps the TV turned up super loud. I've hit a wall with good outcomes for him.

Any advice or pointing to the right direction would be awesome! I may just have to scratch this dx, but I was feeling really good about it to start! =]

Well according to NANDA impaired comfort is ....Perceived lack of ease, relief, and transcendence in physical, psychospiritual, environmental, and sociocultural dimensions

Defining Characteristics

Anxiety; crying; disturbed sleep pattern; fear; illness-related symptoms; inability to relax; insufficient resources (e.g., financial, social support); irritability; moaning; noxious environmental stimuli; reports being uncomfortable; reports being cold; reports being hot; reports distressing symptoms; reports hunger; reports itching; reports lack of ease or contentment in situation; restlessnessI disagree with your instructor for you could use chronic pain but she is the boss. I slo disagree that if it is being cared for it isn't a concern His heel brakdown will continue to be a problem as long as he is in bed and needs constant intervention to prevent worsening.

If his had is contracted has he had a CVA? How does he do with ADLs does he need help?

So he has had a fresh surgical procedure?

Sure he has risk for infection....and that is a good risk for diagnosis. but is this all this patient needs? I think with a fresh surgical procedure and 2 drains pain would still be an issue and a new one. Did you do drsg changes? how did the suture line look?

He does have the new flap, but they have a wound care nurse. I didn't get to see a suture line. Or his heels. But per the wound care nurse, his suture line looked good and his heel ulcers were getting smaller finally.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Impaired (or altered?) comfort r/t peripheral neuropathy aeb c/o pain at 4/10.

Patient's level of pain decreases aeb:

altered comfort is not on the 2012-2014 NANDA list. Your patients impaired comfort is not related to pain.....you need to follow NANDA definitions....according to NANDA impaired comfort is ....Perceived lack of ease, relief, and transcendence in physical, psychospiritual, environmental, and sociocultural dimensions

Defining Characteristics

Anxiety; crying; disturbed sleep pattern; fear; illness-related symptoms; inability to relax; insufficient resources (e.g., financial, social support); irritability; moaning; noxious environmental stimuli; reports being uncomfortable; reports being cold; reports being hot; reports distressing symptoms; reports hunger; reports itching; reports lack of ease or contentment in situation; restlessness

I like to nap a lot,
it makes the day go by faster.
"

Has been in a room in bed for almost 2 months.

Regarding his girlfriend, stated,
"She can't visit, she is in a nursing home and health wise worse off than I am."

Children, grand kids and girlfriend all live in [in a town more than 1 hour away].

Stated "I'm really shy, but the more we talk, the more I open up"

Expressed uncomfortable feelings regarding when "people speak down to me.
I'm 6'1", I'm not used to it, I'm usually the one looking down while standing in conversation.
I feel anxious sometimes."

This man has been alone in a room in bed for almost 2 months, talked about his family but never mentioned if they visited,
sleeps all day, requests his door be kept shut all the time, and keeps the TV turned up super loud
.

While those at risk factors are present.....are they the most important and the only thing your patient needs?
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I think his risk of infection from the cath is important, keeping an eye on the adverse effects of his medications. It seems like his social/mental status would be important...I guess I'm just missing something!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

They are important....and they need to be included. Your instructor has taken away the real ones, impaired skin, because they are being cared for by the wound nurse....I disagree with her/him but you need to do what the person grading them requires.

Your patient also has impaired mobility. Anxiety. You have these two picked for diagnosis in your mind and are having trouble looking at the bigger picture....what your assessment showed you and how to address ALL the issues not just the ones you thought of first (trying to sound thorough) and the ones that "sounded good".

You need to rewrite the impaired comfort diagnosis. To something like...impaired comfort related to perceived lack of ease and psycohspirtual environment AEB statements "people speak down to me. I'm 6'1", I'm not used to it, I'm usually the one looking down while standing in conversation. I feel anxious sometimes.", "She can't visit, she is in a nursing home and health wise worse off than I am."I like to nap a lot, it makes the day go by faster."

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Ahh....makes sense! Doh....Ok, that one was goofed by me then. Sometimes I feel like I won't ever get teh bigger picture! I noticed you had some links on your posts, I liked the flow of the critical thinking flow sheet. Would it be ok to use it for my next patient? Maybe it'll help out with my view of what all is going on?

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Also Esme12, thank you for your guidance! There is so much information going in and so many possibilities, I still find it hard to pick the things I need out of the air so to speak! =]

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Ahh....makes sense! Doh....Ok, that one was goofed by me then. Sometimes I feel like I won't ever get teh bigger picture! I noticed you had some links on your posts, I liked the flow of the critical thinking flow sheet. Would it be ok to use it for my next patient? Maybe it'll help out with my view of what all is going on?

ABSOLUTELY!!! That is why they are there...you will get it ti takes time. I think this is the hardest thing about nursing...it is a completely different way of thinking.

check out this thread https://allnurses.com/nursing-student-assistance/never-never-pick-917527-page2.html#post7863653

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