Struggling with Nanda Statement for a pt that has been given only 1 month to live

[cbncas]

I am in my first semester of nursing school and I have to write a Nanda Statement for my patient who is 86 and has been given only 1 month to live. He has a bladder tumor, Hydronephrosis. He is currently on morphine. He's extremely fatigued, temp is normal, and doesn't complain of any pain. My clinical instructor suggested I write my nanda on comfort. So I have been sitting here for hours trying to figure what would be appropriate. This is what I came up with, but I know it's terrible. I've never had to write a nanda statement so this is very new. "Readiness for enhanced comfort related to Hydronephrosis as evidence by hematuria and pain in flank." Any suggestions anyone might have would be extremely appreciated. Thank you

[NCRNMDM, ASN, RN]

Does it have to be written on comfort? If the patient denies pain, and has only one month to live, I would focus more on the psychosocial aspect of things. For example, Fear r/t bladder tumor and an estimate of one month left to live AEB (whatever evidence you have of fear). This could include patient statements, body language, crying, behavior, family interactions, etc.

You could also try this: Death Anxiety r/t bladder tumor and impending death (prognosis of less than one month) AEB (whatever evidence you have for this diagnosis).

You could also think about Powerlessness, Anxiety, and Risk for Imbalanced Fluid Volume. The last one might seem odd, but as the tumor progresses, the patient is going to begin to deteriorate. As his condition worsens, he won't be taking in as much fluid, and his body won't be regulating his fluid and electrolyte balance like it should. This will result in imbalanced fluid volume. Because it hasn't happened yet, it's a risk diagnosis and you don't have to write an as evidenced by for it.

It could look something like this: Risk for Imbalanced Fluid Volume r/t inability to regulate fluid intake and output as disease progresses.

[NCRNMDM, ASN, RN]

Also, writing these statements takes time, so don't beat yourself up over it. If you can find one, buy a care plan book, or a NANDA book that lists all the approved diagnoses. This will give you a clue as to how to word things, and may even help you with rationales and interventions. Good luck, and don't worry about the first few care plans. No one ever writes a perfect plan their first, or second, or third time!

[cbncas]

Thank you so much mattmrn2013. It definately takes me hours to do my NANDA. It does have to be on comfort. So what I wrote was "Readiness for enhanced comfort related to the dying process as evidenced by low tolerance for activity, nursing care and difficulty breathing." I spoke to my instructor last night and she approved. So here goes nothing. Thanks for the tips. I do have a Nanda book but its the wording that get me. But I will buy a care plan book and maybe that will help.

Thanks again.

[mindlor]

The biggest issue with your statement is that your aeb refers to pain yet the patient is complaining of no pain. You cannot pull stuuff out of the air, you have to go by the data that your assessment gathered.

[mindlor]

Your new statement is better, but again, your original posting mentioned no difficulty with breathing, you could have left that off. Did you assess his respirations? Lung sounds? Pulse oximetry? You can only use data that you gathered from your head to toe assessment.....

[nurseprnRN, BSN, RN]

""readiness for enhanced comfort related to the dying process as evidenced by low tolerance for activity, nursing care and difficulty breathing.""

this says, "he's ready to be more comfortable because he's dying, and i know this because he has a low tolerance for activity, nursing care, and has dyspnea." doesn't quite hang together, imho.

the defining characteristics of readiness for enhanced comfort are "expresses desire to enhance comfort, ...feeling of contentment, ...relaxation, and ...resolution of complaints." i don't see that in your statement. is it in your assessment? it might be, you just haven't mentioned it.

impaired comfort, otoh, includes a lot of defining characteristics that you might see in a dying man. see if some of them fit your assessment.

powerlessness and anxiety are also likely, as mattmrn mentions. i'd like to also suggest risk for powerlessness, as it shows you are on the lookout for this developing, since he has at least one physiological risk factor (dying).

[clinicalteach]

has to be about comfort? later on when you have to write more nanda/care plans, always use Maslows hierarchy to prioritize. (Thanks Daytonite and Vicki for turning me onto that list! helped a ton of students out iwth it!)