Scenario: A 40-year-old woman was recently diagnosed with Stage II breast cancer
ID: 51724 • Letter: S
Question
Scenario: A 40-year-old woman was recently diagnosed with Stage II breast cancer and had a right side mastectomy this morning and is grieving the loss of her femininity. She has a 13-year-old daughter who becomes over involved in her school activities and wants to get all A’s on her next report card, a 12-year-old son who refuses to talk about his mother’s condition and a husband who starts attending daily religious offerings.
Using nursing judgment develop a 3 part nursing diagnosis statement for each family member which includes one NANDA-I diagnosis, an etiology and the defining characteristics (nursing diagnosis + related to + as evidence by).
Identify the data cluster (grouping of significant data that points to the existence of a patient health problem) used to select the nursing diagnosis.
One (1) assessment to validate each the nursing diagnosis
One (1) outcome statement for each (realistic, measureable and contains a time frame).
Explanation / Answer
Using nursing judgment develop a 3 part nursing diagnosis statement for each family member which includes one NANDA-I diagnosis, an etiology and the defining characteristics (nursing diagnosis + related to + as evidence by).
Patient:
Risk for infection due to surgery and disturbed self concept related to recent right side mastectomy and disturbed body image as evidenced by her grief on the loss of her femininity.
Daughter:
Risk of being inattentive towards the patient related to immatured mindset as evidenced by her involvement in her school activities.
Son:
Risk of develoing impaired social interaction skills related to immatured mindset and ineffective coping to the situation as evidenced by his refusal to talk about his mother’s condition.
Husband:
Risk of acquiring deficient knowledge related to fear regarding the disease as evidenced by his attending of daily religious offerings.
Identify the data cluster (grouping of significant data that points to the existence of a patient health problem) used to select the nursing diagnosis.
1.Stage II breast cancer.
2.Right side mastectomy on this morning.
3.Grieving the loss of her femininity.
One (1) assessment to validate each the nursing diagnosis
Patient: During the history,the nurse learns that her maternal aunt had been diagnosed with breast cancer. Physical assessment findings include Temparature- 98.9°F (37.0°C), BP 1160/67, .
One (1) outcome statement:
Resolving interrupted family processes and post-operative care to prevent infection,proper and hygienic medical dressing daily by a trained nurse and proper medication daily to reduce her pain and illness ,proper counselling of the patient and the family members on a regular basis.
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