Nursing Diagnosis

Welcome to our very last week of blogging! Last week we discussed things that nurses can do to help their patients with pediatric Long QT Syndrome. We called these areas to focus on “nursing interventions.” A nursing intervention is a response to a nursing diagnosis. There is a large difference between a nursing diagnosis and a medical diagnosis. A medical diagnosis is where a provider is trying to identify or treat the condition, whereas a nursing diagnosis focuses on how the body physically and psychologically responds to the disease and treatment.

Five key nursing diagnoses that I will discuss during this blog are:

1) alteration in cardiac output

2) risk for death anxiety

3) risk for ineffective health maintenance

4) risk for ineffective individual coping

5) risk for ineffective community coping

1)    alteration in cardiac output

This nursing diagnosis focuses on how LQTS creates a functional challenge for the heart. Any dysrhythmia (mistimed or uncoordinated heart beats) that occur due to LQTS will often cause a change in how much blood is squeezed effectively from the heart. This is just like a pump that isn’t working appropriately. Adhering to a medication routine and/or following provider recommendations for an implanted defibrillator will help prevent the irregular heart beats from occurring, thus keeping cardiac output consistent (Seattle Children’s Hospital 2015).

           

2) risk for death anxiety

            As I have discussed throughout this blog, LQTS can have very serious and fatal consequences if not properly diagnosed and managed. When a provider explains the seriousness of this condition a risk for death anxiety could occur in both the patient and their family. Counseling may be helpful in teaching coping skills to help manage anxiety.

3) risk for ineffective health maintenance

            There are a lot of changes that occur when a patient is diagnosed with a chronic disease. Especially because I’m primarily focusing on pediatric patients in this blog—health maintenance will require both the patient and family to get on board with these sudden new changes. Examples could include creating a colorful visual medication schedule to help the patient and caregivers know when medications are to be taken. Other factors in this nursing diagnosis include: consistent attendance for medical appointments, access to healthcare providers that understand LQTS, etc.

4) risk for ineffective individual coping

With all of the big changes that come with diagnosis of a chronic disease, we must check in to see how the pediatric patient is coping. Many feelings such as fear and stress can come up as a child begins to understand and take ownership of their condition. Age appropriate interventions such as counseling and support groups can be helpful in assisting a pediatric patient in managing their disease.

5) risk for ineffective community coping

This nursing diagnosis focuses on all of the other members of the patient’s life. For example, symptoms of LQTS exacerbations will often be seen when the child is undergoing physical stress such as during PE in school or at an after school sport. Informing teachers and coaches of signs/symptoms/how to best care for this child will be vital in keeping the patient safe. Similarly, it is helpful for all caregivers and family members to learn how to adjust to changes such as a rigorous medication schedule or exercise limitations that occur when a child is diagnosed with LQTS.

Here’s a table that my professor asked us to create demonstrating a break down of one of the examples that I just listed above in a table format.

Nursing Diagnosis	Related to	As Evidenced By	Nursing Intervention	Goal
Risk for ineffective health maintenance	Pt and family do not fully understand scheduling of medications	Unable to describe care coordination of medication administration	Create visual schedule that parents and child can use to track medication administration	Consistent compliance with taking medication

Source:

Seattle Children's Hospital. (2015, January 1). Long QT Syndrome. Retrieved March 1, 2015, from http://www.seattlechildrens.org/medical-conditions/heart-blood-conditions/long-qt-syndrome/