I'm in my last semester of nursing school and I've written what seems to be 100 careplans. However, this careplan is a 10 page research paper and a huge percentage of my grade. I was given a patient who was originally admitted for A FIFTH hernia repair. After the repair was done, the patient didn't have a BM for several days (7 days) and his stomach became increasingly distended. When the patient temperature shot up to 102 overnight the doctors suspected infected mesh (which they used to repair his hernia). However when back in surgery the doctors discovered he developed a enterocutaneous fistula (the patient was having bowel movements into his abdomen). Needless to say- the patient is now septic and after 28 days of being in the hospital has a poor prognosis. The infection is positive for polymicrobes and is very difficult to treat. With a little bit of history can someone please help me to see if I'm on the right path??

Nursing Diagnosis: Here are some ideas

1) Acute pain r/t surgical intervention (patient is on dilaudid PCA pump and is in an immense amount of pain)

2)impair skin integrity r/t surgical intervention (patient has complicated wound care- one wound vac on superior incision, bowel bag in the middle and a wound vac on the inferior of the incision. Patient also has two bilateral JP drains on intermittent suction)

3) Ineffective breathing pattern (patient has COPD, Asthma- bilateral wheezes on I&E. RR of 24 at rest. Unable to take deep breaths without immense pain)

4) Impaired physical mobility r/t surgical pain/surgical intervention (pt is on bedrest)

The thing thats really bothering me is infection... The pt may die from this infection (so I feel like this is the MAIN concern) however the only nursing diagnosis I know is 'RISK FOR INFECTION' - however the pt already has a very active infection.. Is there any way to incorporate this into the careplan?? Please help!! And please help prioritize these nursing diagnosis. Thank you!

Welcome!

I can help....but I am on the run and need to make dinner. Give me an assessment of the patient with vitals and labs....we will go from there.

Think shock. cardiac output. oxygenation/ventilation/perfusion

I agree. I recently saw a septic client that presented with hypovolemia, dec cardiac output, oliguria, etc etc.

So, break down sepsis. What does sepsis look like? Why does sepsis do that? Then address the pieces of sepsis as they present in your client.

That's how I did mine, at least.

Think about the difference between prescribing nursing actions in a nursing plan of care to help recognize and prevent infection, versus the medical mandate to treat an identified one. That means that the risk is done with-- he has the infection, so your nursing assessment, analysis, and prescribing a plan of nursing care shifts elsewhere.

I understand you want to put something about his having this massive infection n your care plan, so look at it from how nursing would evaluate and treat (by prescribing a nursing plan of care) sequelae of this surgical disaster. Sepsis is your starting point-- read up on that and see where it leads you from a nursing standpoint. There are many things we do for someone like this.

And don't forget his family-- they count as part of your care plan too. Coping, grieving, change in family relationships ...