NURSING - Outcome from allnurses

Nursing Dx: Impaired skin integrity r/t to decreased blood and nutrients to the skin secondary to type 2 DM AEB 3 cm erythematous lesion on the left heel

So, you are saying in your nursing diagnostic statement that this patient's ulcer on their heel is due to decreased blood and nutrients reaching the skin, correct? Are you not allowed to use the wording that NANDA has already provided? I would re-write this as: Impaired Skin Integrity R/T impaired circulation secondary to Type II DM AEB 3 cm erythematous lesion on the left heel.

Outcome: The client will demonstrate improved skin integrity with a 1 cm decrease in erythematous lesion on the left heel by next week.

Outcomes are the predicted results of our independent nursing actions. Outcomes describe patient states that follow and are expected to be influenced by an intervention. Outcomes are based upon these three ideas:

* improvement of the patient's condition
* stabilization of the patient's condition
* support for the deterioration of the patient's condition

What are the nursing interventions you would include for the symptoms of this nursing diagnosis (the ulcer)? I'm thinking that I would have nursing interventions for this nursing diagnosis such as (1) relieve pressure on the heel of the foot by placing patient in an air-fluidized bed (2) the instructions for any dressings and ulcer care. The purpose (goal) of these interventions is to not only to attempt to improve the condition of the ulcer, but to prevent any further enlargement of it AND prevent the outbreak of any new ulcers. These are all potential outcomes. You just have to word them as such. So, since you want to go with improvement of the condition of the ulcer, a much more feasible way to write the outcome would be: In one week progressive healing of the lesion on the left heel will be seen as evidenced by a measurable decrease in the diameter of the ulcer. (If your instructor wants numbers, you will need to go to a really good textbook of pathophysiology and look in the section on the healing of tissues to get that information.)

Nursing Dx: Self-care deficit, bathing/hygiene r/t impaired physical mobility secondary to right hemiparesis

This diagnosis is the impaired ability to perform bathing/hygiene activities for oneself. The related factor is the right hemiparesis not impaired physical mobility. Impaired physical mobility is another nursing diagnosis. You can get more specific with this nursing diagnosis than just saying impaired physical mobility. When you use that "secondary to" part you are specifically referring to a medical diagnosis or condition as the cause of the related factor. The hemiparesis is secondary to what medical diagnosis? stroke? some other disease? And what are the specific defining characteristics (symptoms)? You didn't complete the diagnostic statement. I would re-write this: Bathing/Hygiene Self-care Deficit R/T right hemiparesis secondary to CVA AEB inability to support body in a stable position and hold washcloth at the same time in order to wash self.

Outcome: The client will participate in bathing/hygiene activities daily for a month.

Too broad. Not based on any nursing interventions. Possibility: In one week the patient will independently perform a sponge bath of as much of his body as he can safely reach while seated and supervised by a nurse.

Nursing Dx: Risk for infection r/t impaired skin integrity

I wouldn't repeat the same wording of another nursing diagnosis. I would re-write this: Risk for Infection R/T open wound on left heel

Outcome: The client will exhibit no signs of infection during hospitalization.

OK.

Nursing Dx: Self-esteem Disturbance r/t improved ability to perform usual hygiene practices secondary to burn injury

The structure of a nursing diagnostic statement follows PES, or Problem-Etiology-Symptoms. Remember, your "r/t" stuff is the etiology, or what is causing the problem (nursing diagnosis). I'm not trying to be mean, but I have to ask myself how is "improved ability to perform usual hygiene practices" causing a disturbance in self-esteem? The answer is, it doesn't. (I realize the sandman was throwing bags of silicon at you by now.) "Improved ability to perform usual hygiene" practices does not cause or result in a negative perception of one's self-worth (the definition of low self-esteem). It did sound kind of nice though. When you get tired, put your pencil down and take a nap. Since you've mentioned a burn injury, how about: Self-esteem Disturbance R/T functional impairment of (name a part[s] of the body) secondary to burn injury AEB verbal statements of being helpless.

Outcome: The client will demonstrate healthy adaptation and coping skills in one month.

Again, what are your nursing interventions going to be? They will point you in the direction of your outcomes. In one week the patient will begin to actively assist in his rehabilitation by starting to ask for help in learning to adapt to performing specific self-care ADLs.


Remember PES. Your nursing diagnostic statement has to make rational sense to someone in the nursing business who comes along and reads it. It's a concise statment of your patient's problem, the underlying cause(s) and the symptoms that support and prove the problem and it's cause exists. Those symptoms come directly from your assessment data and form the entire foundation of the care plan. Constructing a care plan is a bit like playing with tinker toys. If some of the parts represent symptoms, some represent nursing diagnoses and some represent related factors, you and I can each take a pile of the same parts and come up with two different structures. The test as to whether one is going to stand up on it's own depends on how strong and appropriate the connnections are between the different pieces. And, then, there's the Leaning Tower of Pisa problem: problem with the foundation, but all the pieces are in place.

I'm tired, so I'm shutting down my computer and going to bed before I keep babbling on. Hope I've been able to give you some useful help and guidance.