According to NANDA-I, the simplest ways to write these nursing diagnoses are as follows: Problem-Focused Diagnosis related to ______________________ (Related Factors) as evidenced by _________________________ (Defining Characteristics). There are 4 types of nursing diagnoses according to NANDA-I. Bilevel Positive Airway Pressure (BiPAP): This is a non-invasive, in-home ventilation therapy that comes with a mask and helps improve breathing as well as reduce hypercapnia (the retention of carbon dioxide in the lungs). Nursing Diagnosis: Failure to Thrive (Infants) related to hypothermia secondary to preterm birth, as evidenced by inadequate weight gain, poor sucking, height, and weight that is inappropriate for age, and a weak cry. St. Louis, MO: Elsevier. Frostbite injuries would warrant surgical debridement to avoid gangrene development. Assess the patients vital signs and characteristics of respirations at least every 4 hours. A nursing diagnosis is a statement that describes a problem related to a patient's disease. During and after each feeding, burp the patient regularly and then lay the patient on the side with the head slightly raised or held chest to chest. A complication of hypothermia, acute pulmonary edema should be treated with antibiotics, supplemental oxygen and diuretics as necessary while in the ICU. An inadequate diet reduces energy stores and limits the bodys capacity to produce heat through calorie consumption. Control the heat source to the patients physiological reaction. Ensure proper disposal of soiled dressings and other items in a double bag. Oftentimes, nurses will monitor the problems while the medical providers prescribe medications or obtain diagnostic tests. This intervention makes the treatment selection easier. The goal of care focuses on preventing further heat loss. There are different classifications of hypothermia, which include: The treatment goals for hypothermia will depend on the subtype and causes. Serum electrolytes chronic hypothermia can occasionally cause hypokalemia. When an infection is present, cut off the lines and equipment, and replace them as necessary. High caloric diet may help provide the energy he/she needs and combat fatigue and weight loss. Other causes could be due to CNS trauma, tumors, Others the cause of hypothermia could either be from, Extremes of age the very young and the very old, especially those without appropriate protection or clothing, People exposed to the cold outdoors for long periods, especially those with poor judgment (e.g. If you continue to use this site we will assume that you are happy with it. Prepare the patient for procedures like escharotomy or fasciotomy if necessary. To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse. Desired Outcome: The patient will experience or exhibit a considerable increase in activity tolerance, with no breathlessness or undue fatigue, and vital signs within the patients accepted level. Desired Outcome: The patient will re-establish a normal core body temperature between 36 degrees Celsius and 37.8 degrees Celsius. She has worked in Medical-Surgical, Telemetry, ICU and the ER.
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nursing diagnosis for cold