What's wrong with my diagnosis care plan?

[Mursely]

So I had a client in clinical who was potassium deficient, but my instructor didn't like my nursing diagnosis because she said it's not a nursing diagnosis.

What would I change about " Potassium deficit rt steroids aeb serum potassium levels less than 3.5" to make it a nursing diagnosis? Should I use Potassium deficit rt to hypokalemia aeb serum potassium levels?

Is that better?

Here is the original, should I change it to rt hypokalemia?

1. Potassium deficit rt steroids aeb serum potassium levels less than 3.5

Goal: Within 48 hours of nursing intervention, client will be able to maintain serum potassium levels within normal range.

Nursing Interventions:

1. Strictly monitor clients' intake and output. (Careful monitoring of fluid intake and output is necessary because 40 mEq of potassium is lost for every liter of urine) (Client voided a total of 1700 ml of urine within only 4 hours)

2. Monitor BUN and creatinine levels (Renal function should be monitored for patients receiving potassium replacement).

3. Supply client with potassium supplements as directed by physicians orders.

4. Make sure client is getting a potassium rich diet.

5. Monitor serum potassium levels (Evaluates the effectiveness of therapy).

[akulahawkRN, ADN, RN, EMT-P]

The reason your professor doesn't like what you wrote is because it's not a nursing diagnosis. Those are written in a certain format:

Problem r/t why the problem exists aeb defining characteristics of the problem.

What you're saying in your statement is that the patient has hypokalemia because the serum K was less than 3.5. You're skipping why the K level is 3.5 and any other characteristics that lead you to believe that the K level is low. The problem is that you're also essentially doing a medical diagnosis. There's a list of nursing diagnoses available and it would behoove you to find those resources because they include a ton of defining characteristics and so much more.

[Mursely]

The client was on corticosteroids which lowered the potassium levels.

So would "Hypokalemia rt corticosteroids aeb serum potassium levels less than 3.5" Be a nursing diagnosis? Or is that still medical?

[cayenne06, MSN, CNM]

The client was on corticosteroids which lowered the potassium levels.

So would "Hypokalemia rt corticosteroids aeb serum potassium levels less than 3.5" Be a nursing diagnosis? Or is that still medical?

You gotta use a NANDA diagnosis, for better or worse.

[akulahawkRN, ADN, RN, EMT-P]

The client was on corticosteroids which lowered the potassium levels.

So would "Hypokalemia rt corticosteroids aeb serum potassium levels less than 3.5" Be a nursing diagnosis? Or is that still medical?

That's the right format, now find the appropriate NANDA statement. It's not going to be a statement limited to K+ being off-kilter...

[Mursely]

risk for injury (lethal arrhythmia/death) related to hypokalemia aeb by serum potassium levels than 3.5

How about that?

[akulahawkRN, ADN, RN, EMT-P]

"Risk for" NDx's don't have "AEB's" because if there are "AEB's" present, then there's an actual problem. Also, the R/T shouldn't be a medical issue... Since there's an AEB here, there's an actual problem present, so no "risk for" diagnosis is appropriate.

A lab value

[Mursely]

Okay, last try, how about this one

Altered fluid and electrolyte balance, hypokalemia rt corticosteroids and excessive loss of fluid and electrolytes by diuretic aeb potassium serum blood level less than 3.5

[la_chica_suerte85, BSN, RN]

If it helps, hypokalemia is not a nursing diagnosis but a medical diagnosis (in other words, it requires intervention that a physician would be responsible for, not a nurse, such as prescribing potassium supps). You have to use NANDA Dxs. You're trying to make your care plan fit around the hypokalemia. There are lots of nursing interventions but that requires that the pt be exhibiting s/s of hypokalemia (i.e. dysrhythmias) or is doing things/exhibiting behaviors to make it worse (i.e. not eating foods rich in potassium). For instance, why is your pt on corticosteroids? Is the pt there because of the hypokalemia? There could be an Ineffective Self-Health Maintenance Dx in there if your pt does not know how to manage his/her health with this treatment.

[NurseGirl525, ASN, RN]

Do you have a nursing dx book? You can't make them up. You need to pick from NANDA approved dxs. Not a medical dx. You can't change the words in a nursing dx to fit your situation either. Risk for dxs do not have aeb. Get out your nanda book and start looking.

[akulahawkRN, ADN, RN, EMT-P]

Okay, last try, how about this one

Altered fluid and electrolyte balance, hypokalemia rt corticosteroids and excessive loss of fluid and electrolytes by diuretic aeb potassium serum blood level less than 3.5

I seriously suggest getting a Nursing Dx book as Heathermaizey suggests. Also, as stated, you can't effectively directly go from a medical Dx to a Nursing Dx.

The format you're using is almost there, though I can't find an "altered fluid and electrolyte balance" Nursing Dx. Why is the patient on corticosteroids and what can that do to the body? It's possible that several Nursing Dx's can come out of this exercise...

You're looking for "defining characteristics" which form the basis of a nursing diagnosis.

[Esme12, ASN, BSN, RN]

Okay, last try, how about this one

Altered fluid and electrolyte balance, hypokalemia rt corticosteroids and excessive loss of fluid and electrolytes by diuretic aeb potassium serum blood level less than 3.5

Your diagnosis isn't acceptable as it is not a NANDA approved diagnosis. What care plan resource are you using?

Care plans are all about the patient and the patients problems. Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

What is your assessment? What are the vital signs? What is your patient saying?. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future. What is YOUR scenario? 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.

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.