UNIT 6 Risk Diagnosis
Introduction
Risk Diagnosis
A risk diagnosis is a statement implicating that a health problem does not yet exist, but that the patient is at a higher than normal risk of developing it in the near future. In other words, certain risk factors are present in the client. The risk diagnosis contains the phrase Risk for followed by the diagnostic label listing the specific risk factor(s). An example of a risk diagnosis is: Risk for injury related to altered mobility and disorientation. Similar to an actual nursing diagnosis, the definition in a risk diagnosis expresses a clear and precise meaning of the diagnosis.
Content goals
In this module the student will:
1. Review and use phrases and idioms people used when making a risk diagnosis
2. Identify and demonstrate proper note-taking techniques; take notes of a risk
diagnosis
3. Listen to an interview with a patient and make a risk diagnosis
4. Identify actual diagnosis two-part statements
5. Review the past perfect tense
6. Practice making a risk nursing diagnosis based on an case
7. Identify ways to improve communication between health care workers and clients.
Unit 6 RISK DIAGNOSIS H6:1 Terminology/Vocabulary Development
Idiom/ phrase/word / Meaning / Exampleliving it rough / homeless/ person who lacks housing and basic resources / The number of people living rough in the streets has increased dramatically in the United States.
shoot- up / The act of shooting up in most cases an illegal drug. / The police caught the man shooting-up and immediately arrested him.
do drugs / to take illegal drugs / The singer confessed to doing drugs.
I’ve gotten my act together / to put things in order in ones life and be more responsible / After many years of doing nothing, Karen finally got her act together and started college.
can’t keep it down / to vomit / Three months pregnant, Marcia couldn’t keep anything down and began to lose a little weight.
makes me sick/ puke / feel nauseous/ vomit / When I was pregnant the smell of fish would make me sick / puck.
nasty / diarrheaddd di bad / horrible / The wound looked nasty. It was red and oozing pus.
feeling down in the dumps / depressed / Ricky felt down in the dumps after losing his job and being unemployed for over a year.
a bug / A disease-producing micro-organism / minor temporary illness / The kids came down with some sort of bug that caused a slight fever and upset stomach.
having trouble catching (my) breath / shortness of breath / John, who suffers from asthma, often has trouble catching his breath after a short walk.
… give it to me straight / tell me the truth / The terminally ill patient wanted the doctor to give it to him straight and tell him how long he had to live.
A. Read the following words / phrases, their definitions and example of usage.
B. Read the sentences and choose the best word from the box to complete each sentence.
bug nasty feel down in the dumps made the nurse sick do drugs1. During chemotherapy, the patient started to______and was not as responsive.
2. People who ______and share needles are more prone to getting hepatitis or AIDS.
3. Many students got ill from a ______that was going around school.
4. Watching an autopsy for the first time ______.
5. The man suffered a ______cut to the forehead in the accident.
Unit 6 RISK DIAGNOSIS H6:2 Listening & Writing
A. Listen to and complete the following sentences with the words and expressions from your vocabulary list.
1. Some Olympic athletes have been suspended because of ______steroids to improve their strength.
2. Peter, who suffers from AIDS, needs an oxygen mask because he is having trouble ______.
3. The smell of anything burning made Lisa ______because it reminded her of the fire.
4. Robert swore that he ______and would find a job in order to support his family.
5. Because of lack of job opportunities and poverty, many people are now having to ______and often suffer from hate crimes and violence.
6. After waking up from anesthesia, it is often difficult to ______for a few hours.
7. Putting her hand up to her mouth, the little girl ran up to her teacher and told her she was going to ______.
8. ______, the lonely old man sat no longer left his house and stopped socializing with his friends.
B. Listen to the following conversation taking place between nurse Joy Adams and a 34 year old homeless patient. You will hear the conversation twice. The first time just listen, the second time fill in the blanks with the phrases, letters or numbers you hear. Finally, listen again and recheck your answers.
Nurse Adams: Mr. Gordon, you said you are homeless is that correct?
Mr. Gordon: Yes. I lost my job, and home and have been ______in the streets now for five years.
Nurse Adams: At the present are you on any drugs or medication?
Mr. Gordon: I used to ______once in awhile, but I’ve ______and am clean now.
Nurse Adams: I see. Did you ever share needles with any other person?
Mr. Gordon: Once in a while. But like I said, I no longer ______.
Nurse Adams: Mr. Gordon, is there any particular reason why you have come to the clinic today?
Mr. Gordon: Yeah. I don’t feel like eating and ______. Just the thought of food ______.
Nurse Adams: How often have you been vomiting?
Mr. Gordon: Well for some time now. Just the thought of food makes me want to ______.
Unit 6 RISK DIAGNOSIS H6:2 (Cont.)
Nurse Adams: Does your body ache?
Mr. Gordon: Yeah. All over, I just don’t feel like moving or anything. My body aches and I feel like I have a slight fever.
Nurse Adams: How long have you been feeling like this?
Mr. Gordon: Oh, I wanna say……………..for at least a month now. Nurse, I’ve noticed these sores on my arms have really turned ______and refuse to heal. I am just a mess right now and am really ______.
Nurse: How long have you had the sores? And can you tell me how they have been red like this?
Mr. Gordon: Like a said, about a month now.
Nurse: Do you have diarrhea?
Mr. Gordon: Yes. It comes and goes. Thought I had ______but I am not getting any better and I seem to be getting worse.
Nurse Adams: Is there anything else you’d like to tell me?
Mr. Gordon: Well, lately, I’ve been ______. I don’t know what’s wrong with me. What have I done to deserve all this? Just when I start getting my act together I go and get sick like this.
Nurse Adams: I am sure things will be okay. I just have one more question to ask you before the doctor comes in. How long have you had your cough?
Mr. Gordon: Oh, I’d say about two months now. It keeps me awake at night.
Nurse Adams: Well, Mr. Gordon the doctor will soon be in to see you.
Mr. Gordon: Nurse what’s wrong with me? I’m not dying am I? I can take it! You can ______.
Nurse Adams: Like I said Mr. Gordon the doctor will be in to see you soon. Bye.
Unit 6 RISK DIAGNOSIS H6:3 Note Taking
Note Taking:
A.Tips for taking notes while making an at risk nursing diagnosis:
A nursing diagnosis is different from a medical diagnoses in that the nursing diagnosis focus on human response to stimuli, whereas, medical diagnosis focus on the disease process. A nursing diagnosis identifies potential or possible problems. The diagnosis of "at risk for aspiration" is an example of a diagnosis that recognizes the potential for a given problem to occur. For an at risk diagnosis to be made, risk factors must be present and identified upon assessment. In this example, the absence of the gag reflex, and the presence of facial droop or paralysis may be among the risk factors for impaired swallowing that would lead a nurse to make the diagnosis of "at risk for aspiration."
Another example of a family nursing diagnosis is "risk for altered parent-infant attachment." In this case, the nursing diagnostic statement might read, "risk for altered parent-infant attachment related to maternal distancing as evidenced by lack of eye contact between mother and infant." These diagnoses are important because they allow nursing to take a preventive approach to patient care.
B. Listen again to the conversation between Nurse Adams and Mr. Gordon. Write down your nursing diagnosis. It should include an at risk diagnosis.
______
Unit 6 RISK DIAGNOSIS H6:4 Listening & Writing
Listening:
B. Listen carefully to a short introduction to a case history and fill in the blanks with the appropriate words or phrases.
Jose is a ____-month-old ______who was referred to ______after being returned to his home with his mother from the children's home of the county. Jose; his
_____-year-old sister, Rosa; and _____-yearold sister, Maria-Carmen, ______from their home by the juvenile ______while their mother, Teresa, completed a ______rehabilitation ______. At the present, Teresa is ______and is supported by ______. Her family support consists of her aunt, who has a history of ______. Teresa has an ______grade education. The public health nurse (______) was referred to the home to check on Jose’s growth and development and to connect Teresa and the family to ______resources.
C. Critical Thinking: Mrs. Murry was admitted to your unit an hour ago. The following data has been written on her chart. Which data are subjective (personal) and which are objective(based on facts)? Write “S” or “O” in front of each piece of data.
___Temperature 101˚F ___Pulse 98, irregular
___Nausea ___Vomiting for 2 days
___ “My back aches” ___Skin flushed and hot
___Closes eyes and grimaces when blinds are opened ___Rash all over body
D. Use the following phrases in sentences of your own.
1. a bug:______
2. makes me sick:______
______
3. feeling down in the dumps: ______
______
Unit 6 RISK DIAGNOSIS H6:5
Grammar Tips
Grammar Note: Past Perfect Tense
In this module, you will be introduced to the past perfect tense. The following page contains many examples of the past perfect tense in use.
E.g. Maria-Carmen had been removed from their home by the juvenile court.
E.g. The living room window was cracked and had been duct-taped.
You can sometimes think of the past perfect tense like the present perfect tense, but instead of the time being now the time is past.
When we want to describe an action that started in the past and finished in the past we use the following formula:
subject + had + past participle
I had worked all day. He had worked all day.
You had worked all day. She had worked all day.
We had worked all day. It had worked all day.
They had worked all day.
Imagine that you arrive at the bus station at 6:30am. The stationmaster says to you:
"You are too late. The bus has left."
Later, you tell your mother:
"I was too late. The had had left."
We often use the past perfect tense in reported speech after verbs like said, told, asked, thought, wondered:
Unit 6 RISK DIAGNOSIS H6:6 Case Study
A. Put the verbs into the correct form (past perfect).
2. The nurse ______(decide) that the infant was in danger of harming himself.
3. The mother ______(neglect) to feed her children.
4. The patient ______(check) herself out of the ward.
5. How long had the patient had a fever?
He ______(have) a fever for three days.
6. The doctor explained that Mr. Allen ______(have) a mild heart attack.
A. Study the following case and be prepared to make a nursing diagnosis based on the data given.
Jose is a 13-month-old infant who was referred to Public Health Field Nursing after being returned to his home with his mother from the children's home of the county. Jose; his 3 1/2-year-old sister, Rosa; and 14-yearold sister, Maria-Carmen, had been removed from their home by the juvenile court while their mother, Teresa, completed a drug rehabilitation program. At the present, Teresa is unemployed and is supported by AFDC. Her family support consists of her aunt, who has a history of alcoholism. Teresa has an 8th grade education. The public health nurse (PHN) was referred to the home to check on Jose’s growth and development and to connect Teresa and the family to community resources.
Upon arriving at the apartment complex, the PHN walked through an area with broken glass and past a pool area with a broken gate. Teresa’s apartment was on the second floor, facing the pool. A 3 1/2-year-old was playing unattended at the top of the stairs.
The PHN noted that the living room window was cracked and had been duct-taped along the broken edges, and the door had one large hole. She knocked on the door five times, the door opened slowly, and a woman looked through the security chain. Upon questioning, the woman said she was Teresa and eventually opened the door. The house was dirty and smelled like unwashed dishes and dirty diapers. Teresa’s breath smelled of alcohol. Flies were sitting on half-eaten bowls of cereal that were on the kitchen table. Roaches could be seen on the kitchen cabinets.