Trouble with prioritizing dx and including rationale

[jennyanne33]

I haven't done a care plan in about 10 years and have never had to do one for work. I am now back in school to get my RN. I am taking an online class that we need to do a care plan on a pt. I actually chose my 4 year old son. Some back ground: He's 4, since he's been 1 1/2 he only sleeps 2 hours a day total. He was put on Clonidine for him to sleep. He has been dx with ADHD and mood disorder also. If I don't give him his med at night he has stayed up for 43 1/2 hours before finally falling asleep on his own. Also he is extremely constipated and has been admitted to the hospital on 2 seperate occasions for cleaning out which the last time he needed 13 1/2 gallons of Go-lytely to clean him out. He still suffers from constipation and needs to to be managed with exlax, suppositories and enemas and still only has a BM about once every 2 weeks. He also does not eat. He barely eats at all. Very rarely eats a whole meal if any. Also says he's not hungry and that is all day.

I need to prioritize the nursing dx according to Maslow's and this is what I came up with, but I'm having a hard time with rationale for the way I did it. Could anyone help me please. I'm confusing myself...I have spent almost 30 hours on it already and still not done. Thanks!

1. Imbalanced Nutrition: Less than body requirements R/T pt refusing to eat during meals AEB reported food intake less than recommended minimum daily requirements.

2. Altered Sleep R/T client unable to sleep more than 2 hours per night AEB client need for medication to sleep more than 2 hours per night

3. Constipation R/T irregular evacuation patterns AEB pt unable to evacuate stool on a regular basis

4. Risk for Injury R/T increased actiivity level, impulsivity and lack of fear

5. Disturbed thought process R/T inability to concentrate and control impulses AEB observed irritablility and unable to concentrate on tasks required

6. Ineffective coping R/T destructive behavior towards self and others AEB verbalized physical coping mechanisms

[AggieNurse99, BSN, RN]

Imbalanced nutrition - is there any evidence of this like poor growth, physical S&S of malnutrition? Could the inadequate food intake be causing some constipation? i.e. constipation r/t imbalanced nutrition: less, AE of ADHD meds AEB....

As these were taught to me, all your interventions focus on the R/T factors, so by "nursing" the R/T problems, you "treat" your nursing diagnosis. Also, I think your R/T and AEB factors need more evidence. I.E. ineffective coping AEB "verbalized physical coping mechanisms" like what? What statements did he make?

[jennyanne33]

He does show some signs of malnutrition, like he's very pale, dark circles under eyes, his ribs stick out, he's under the 50th percentile for his weight. He doesn't eat really at all. He only picks at food.

The doctors don't know what is causing the constipation. THey do know about his lack of eating and he's not on any ADHD meds yet until he gets into school. His coping skills when I asked what he does when he gets angry, he said "I hit myself or I hit other people or I break things."

I haven't done this in a long time so I'm having a hard time with doing it, especially since its an online class and I have no in-person instruction. Thanks for all your help.

[AggieNurse99, BSN, RN]

Care plan: Nanda diagnosis r/t intervenable factors AEB specifics from your assessment. Outcome Statement. Interventions. Evaluation (re-assessment).

[Nursing process - ADPIE]

So your diagnosis for imbalanced nutrition:

Imbalanced nutrition: less than body requirements r/t ______ AEB "he's very pale, dark circles under eyes, his ribs stick out, he's under the 50th percentile for his weight"

A) what's your measureable goal (outcome statement)

B) Interventions directed toward the r/t factors

C) Evaluation

6. Ineffective coping R/T destructive behavior towards self and others AEB verbalized physical coping mechanisms

Here - is the destructive behavior a r/t factor or an AEB?

could the r/t be more - frustration with inability to problem solve- or something along the lines of the human response to a medical condition

AEB "I asked what he does when he gets angry, he said "I hit myself or I hit other people or I break things."

The prioritizing along maslow, well...after ABCs you could argue the lack of sleep and nutrition and constipation all in the top spot. The three are all probably interrelated. I'd look up some of DayToNite's posts. Daytonite really got me through the careplanning process.