RN Diagnosis Chronological order

Mavrick, BSN, RN · Jul 30, 2015

This is a good time for a quote from "Avatar" Moat: It is hard to fill a cup that is already full.

allinoneplace01 · Jul 30, 2015

Pressure ulcers are localized injury to the skin and/or underlying tissue usually over a bonyprominence (e.g., the sacrum, trochanter, ischium, or heel), as a result of pressure, or pressurein combination with shear and/or friction. In 2009, the National Pressure Ulcer AdvisoryPanel (NPUAP/EPUAP) defined a pressure ulcer as localized injury to the skin and/orunderlying tissue usually over a bony prominence, as a result of pressure, or pressure incombination with shear. Friction generates shear and when friction is high, the shear is alsohigh, so the inclusion of shear presumes the presence of friction (L. Edsberg, personalcommunication February, 2010; WOCN, 2010, p. 1).

Either or, the patient has an ulcer. Can you change that? If I put friction ulcer, how can you tell? And it was over a bony prominence, but primarily was from the combination of pressure and friction with friction being predominant for stage 1 ulcer.

I am going to go with the guidance of the hospital, the CI, the professors. And, to project against a PhD is immature, because she has practiced for more years than yourself. And the Lead RN, and the CI state support and I noted the reasons.

I am sure that at your hospitals, and your experience you may be correct. At the hospital I am at your diagnoses priority would be incorrect. I am not going to project against your experience, or if you have a PhD or do not. And for a quote, "Half of what you learn today [. . .] will either be dead wrong within 5 years of your graduation." Perhaps, the learning structure has changed. They still call degenerative joint disease as osteoarthritis, but the terminology has changed. And, where I go to school, or a PhD, please continue on with the mentality of projection -- b.c. it suit you. Education is a gift, and some institutions may have different standards than other hospital institutions. Of course, if I go to another institution and they tell me to notate a different way I will adjust. Take care.

allinoneplace01 · Jul 30, 2015

Please define why soiled underpants does not relate to human dignity. That makes no sense to me.

Here.I.Stand, BSN, RN · Jul 30, 2015

Nobody said soiled underpants don't relate t human dignity. What they said was soiled underpants aren't proof of impaired human dignity. Do sharp teeth on an animal prove they eat meat? No. Does soiled underpants prove that the patient is humiliated about it? No. What the patient *says* about it is going to show how they perceive their dignity.

These are two made-up examples of pts with soiled underwear to illustrate my point:

#1 comes up soiled, and in tears. I tried to hold it but I just couldn't. My boyfriend laughed at me! I'm so humiliated!!

#2 comes up drunk as a skunk and doesn't even realize her pants are soiled.

You may perceive both situations as undignified--and yes, both pts need to be cleaned up--but only pt #1 is experiencing distress as the result of impaired dignity.

Jensmom7, BSN, RN · Jul 30, 2015

Pressure ulcers are localized injury to the skin and/or underlying tissue usually over a bonyprominence (e.g., the sacrum, trochanter, ischium, or heel), as a result of pressure, or pressurein combination with shear and/or friction. In 2009, the National Pressure Ulcer AdvisoryPanel (NPUAP/EPUAP) defined a pressure ulcer as localized injury to the skin and/orunderlying tissue usually over a bony prominence, as a result of pressure, or pressure incombination with shear. Friction generates shear and when friction is high, the shear is alsohigh, so the inclusion of shear presumes the presence of friction (L. Edsberg, personalcommunication February, 2010; WOCN, 2010, p. 1).
Either or, the patient has an ulcer. Can you change that? If I put friction ulcer, how can you tell? And it was over a bony prominence, but primarily was from the combination of pressure and friction with friction being predominant for stage 1 ulcer.
I am going to go with the guidance of the hospital, the CI, the professors. And, to project against a PhD is immature, because she has practiced for more years than yourself. And the Lead RN, and the CI state support and I noted the reasons.
I am sure that at your hospitals, and your experience you may be correct. At the hospital I am at your diagnoses priority would be incorrect. I am not going to project against your experience, or if you have a PhD or do not. And for a quote, "Half of what you learn today [. . .] will either be dead wrong within 5 years of your graduation." Perhaps, the learning structure has changed. They still call degenerative joint disease as osteoarthritis, but the terminology has changed. And, where I go to school, or a PhD, please continue on with the mentality of projection -- b.c. it suit you. Education is a gift, and some institutions may have different standards than other hospital institutions. Of course, if I go to another institution and they tell me to notate a different way I will adjust. Take care.

I actually was just being a bit of a smart aleck because you keep coming across as pompous and condescending. Feel free to pontificate on, I'm done here.

I

allinoneplace01 · Jul 30, 2015

I agree that my Diagnosis, r/t soiled underwear, as evidenced by (this portion needs better wording -- I should state as evidenced by facial expressions of ex. embarrassment). You are completely correct, I definitely messed up there! Now, for another topic, non-verbal cues, can they be included as evidence? I do not see why not because communication is 90% non-verbal.

allinoneplace01 · Jul 30, 2015

I apologize if I came off wrong. But, "jensmom" two wrongs do not make a right. One team, one fight. I am simply learning. I feel that other hospitals have different structures, is all. Perhaps because it is finals week my wording was in error. I feel unsure.

nurseprnRN, BSN, RN · Jul 31, 2015

Now, she did say that some hospitals may follow Maslow guidelines, but according to my location they follow Nanda. So, in your scenarios/hospitals your ranking may be precise to your hospital's criteria. Thank you for the new knowledge about other hospital's criteria. Have a good week.

Again, NANDA-I does NOT "prioritize" any nursing diagnoses. If you think it does, give me the citation in the current edition (2015-2017) and I will stand corrected. Hospitals do not "follow Nanda (sic)," either.

Nursing diagnosis and Maslow's Hierarchy of (Human) Needs are not some either-or choice. The definition of nursing by the ANA, which with the Scope and Standards o Nursing Practice is binding upon all of us, is:

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury,

facilitation of healing, and

alleviation of suffering

through diagnosis, treatment of human response, and advocacy

in the care of individuals, families, groups, communities, and populations.

~ ANA, 2015

Perhaps you can see how Maslow's Needs dovetail with this. I am glad you are taking up the flag of advocacy for your patient. I believe that in time you will come to realize that facilitating healing and preventing worsening of an existing wound (check that too-- friction damages skin and disrupts the tissue planes over a bony prominence by shearing forces, not a likely cause of an inguinal skin breakdown; this is separate from decreasing local circulation by pressure even though both can certainly occur in the same area contemporaneously) is addressing a higher human need than dignity does NOT mean that dignity goes out the window.

You are a student and you don't always understand what they're saying to you. I think you may have not explained yourself as well as possible to your sources; they may have thought that you meant it as an either-or situation, when it's not. Time will cure all of this.

Good luck to you.

allinoneplace01 · Jul 31, 2015

Thanks for the broadened scope. I rotate in 5 hospitals in the fall, so I certainly will compare further. Thanks. And, I will look further into the clinical RN book. I meant to say my educational clinical curriculum at hospital follows NANDA r/t my clinical book.