same MDC1 Module 4

Module 04 Written Assignment – Nursing Diagnosis

Purpose of the Assignment

1. Assist students in clustering assessment data when developing a nursing diagnosis.

2. Develop students’ ability to write client-based outcomes when planning care.

Course Competencies

· Explain components of multidimensional nursing care for clients with musculoskeletal disorders.

Instructions

Using the template below, write 3 NANDA-I approved nursing diagnoses in a proper format based on the client case provided below. Write one SMART client-centered goal for each nursing diagnosis. Consider the client’s medical history and medications.

Kacie Benson, a 19-year-old woman, is a client on your unit due to a skiing accident. She is unconscious and may or may not regain consciousness. She is on complete bedrest. She requires frequent repositioning to maintain correct body alignment and attention to her ROM. She responds to painful stimuli with slight non-purposeful withdrawal. No spontaneous movements are noted. The recent lower extremity ultrasound showed no evidence of venous thrombosis, and she continues on low molecular weight heparin injections. Her fluid and electrolyte balance is being maintained by a tube feeding at 60 mL per hour continuously. She is incontinent of stool and has an indwelling Foley catheter. Her heels are reddened, but otherwise, her skin is intact.

Use at least two scholarly sources to support your nursing diagnoses. Be sure to cite your sources in-text and on a reference page using APA format.

Check out the following link for information about writing SMART goals and to see examples:

http://rasmussen.libanswers.com/faq/212524

You can find useful reference materials for this assignment in the School of Nursing guide:

https://guides.rasmussen.edu/nursing/referenceebooks

Have questions about APA? Visit the online APA guide:

https://guides.rasmussen.edu/apa

Module 04 Written Assignment – Nursing Diagnosis Rubric

Total Assessment Points - 35

Levels of Achievement
Criteria	Emerging	Competence	Proficiency	Mastery
Nursing Diagnosis (should fit the data) (10 Pts)	Nursing diagnoses are insufficient and/or do not fit the data. Failure to submit Nursing Diagnosis will result in zero points for this criterion.	Writes ONE NANDA-I approved nursing diagnosis in the correct format (including related to/as evidenced by) with a strong connection to identified data.	Writes TWO NANDA-I approved nursing diagnoses in the correct format (including related to/as evidenced by) with a strong connection to identified data.	Writes THREE NANDA-I approved nursing diagnoses in the correct format (including related to/as evidenced by) with a strong connection to identified data.
	Points – 7	Points – 8	Points - 9	Points - 10
SMART Goal (should reflect the diagnosis and follow guidelines) (15 Pts)	The goals meet few SMART goal guidelines and/or are not related to the nursing diagnoses. Failure to submit SMART goals will result in zero points for this criterion.	Writes ONE goal for ONE nursing diagnosis and the goal meets all the SMART goal guidelines and are related to the nursing diagnosis.	Writes ONE goal for TWO nursing diagnoses and the goals meet all the SMART goal guidelines and are related to the nursing diagnoses.	Writes ONE goal for THREE nursing diagnoses and the goals meet all the SMART goal guidelines and are related to the nursing diagnoses.
	Points – 11	Points - 12	Points - 13	Points – 15
Spelling and Grammar (5 Pts)	Numerous spelling and grammar errors, which detract from the audience's ability to comprehend material.	Some spelling and grammar errors, which detract from the audience's ability to comprehend material.	Few spelling and grammar errors.	Minimal to no spelling and grammar errors.
	Points: 2	Points: 3	Points: 4	Points: 5
APA Citation (5 Pts)	APA in-text citations and references are missing.	Attempted to use APA in-text citations and references.	APA in-text citations and references are used with few errors.	APA in-text citations and references are used correctly.
	Points: 2	Points: 3	Points: 4	Points: 5

Module 04 Written Assignment-Nursing Diagnosis

Name

School

COURSE#: NUR2356

Instructor name

November 1st , 2020

Nursing Diagnosis and Goal

1. Diarrhea related to infection as evidenced by > 3 liquid stools in 24 hours Comment by Christina Cyrus: Actual problem the client is experiencing right now Comment by Christina Cyrus: The etiology or reason the client is experiencing the problem Comment by Christina Cyrus: The subjective or objective evidence of the problem

· Client will report less than 3 liquid stools in a 24-hour period within 3 days

2. Risk for dry eye as evidenced by contact lens wear Comment by Christina Cyrus: A potential problem a client may have because of a risk factor you identified. The client DOES NOT currently have the problem. If they currently have the problem-it is a problem focused diagnosis and then refer back to #1. Comment by Christina Cyrus: The risk factor you identified that put the client at risk of developing the problem

a. Client will state eyes are comfortable without itching, burning, or dryness while wearing contacts

3. Readiness for enhanced knowledge as evidenced by client statement of “I want to learn more about my COPD diagnosis” Comment by Christina Cyrus: Health promotion is when the client expresses a desire to change or improve their health status. Comment by Christina Cyrus: This is the evidence that you obtained that informed you that the client was ready to change their health status. It is typically a client statement to that effect.

a. Client will teach back to the nurse three ways to manage their COPD without medication prior to discharge.

References

Author’s Last Name, First initial. Middle initial. (Year). Title of article. Journal Title, Volume Number(Issue number), Page numbers.