ESRD Nursing Diagnosis - page 2

by RStudentRN

39,166 Visits | 15 Comments

o.k here was another question that I got stumped on... Your patient has End Stage Renal Disease, with a 30 year HX of Type 1 DM. She has a 2-cm dry, ulcerated circular area on the lateral outer aspect of her right great toe... Read More


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    I just get out from my clinic day. My guy is going to be discharged tomorrow and I did all assessment on him.
    BTW, I totally agree with you that your diagnosis going with your assessment. But I still feel I do not get those knowelage to make these two match well.

    His foot ulcer is progressive well which is what he told me since i can not open his dressing to see. It is said the same as the notes from another nurses.

    He has no pain. He is on 800 Cal diet. He lost 30 LB during about 1 month hospitalization.

    On his right foot, the poplite pulse was absent. The tem of his right foot. is lower than his left foot which has a wound dressing on.

    His heart and lung sounds are clear. His BP is 98/58, pluse is 74. The doctor stop his antibiotic 2 days ago. Glucose 147.

    I am thinking to go with teaching since he is going to be discharged tomorrow. I do talked about how important for him to manager his diet to take care his glucose level.
    His wife came and told me she wants to buy a BP cuff so I am thinking he really need to know more about how to manage his health problem. I know they are trying. He also states: I know it been taken care much more here than by myself at home. ( Sorry, I am not sure i am sounds right, I am seconde language speaker).


    Do you think it is make sense to you to have diagnosis with "teaching"?

    Thanks again!
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    ok. . .i went through the information you posted and i came up with a list of your patient's symptoms from what you provided. this would be step #2 of the nursing process (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnosis to use). this is the list:
    • 30 pound weight loss during 1 month hospitalization
    • popliteal pulse was absent in right foot
    • temperature of right foot lower than left foot
    • elevated glucose of 147
    • his wife told me she wants to buy a bp cuff
    • they are trying
    • patient states: "i know it been taken care much more here than by myself at home."
    now, these should all be considered symptoms, or in nanda language defining characteristics. the next thing we need to do is match some of these symptoms with nursing diagnoses.
    the weight loss indicates a nutrition problem. a thirty pound weight loss in one month is a big weight loss! can you lose 30 pounds in a month? i'd love to lose 30 pounds in a month! it take 3500 calories to make a pound, so this patient was using up at least 3500 calories a day! that's a huge requirement of energy. this definitely meets the defining characteristics of imbalanced nutrition: less than body requirements r/t long-term illness aeb 30-pound weight loss in the past month. include dietary teaching about a diabetic diet in the nursing interventions for this nursing diagnosis. also include weekly weights. web pages: [color=#3366ff]imbalanced nutrition: less than body requirements and http://www1.us.elsevierhealth.com/me...ex.cfm?plan=37

    with absent popliteal pulses and skin temperature changes you have a circulation problem in the left foot along with the ulcer. you've got ineffective tissue perfusion, peripheral r/t interruption of blood flow aeb absent popliteal pulse in the right foot and skin temperature of right foot lower than left foot. in addition, you have impaired skin integrity r/t impaired circulation and metabolism secondary to diabetes mellitus aeb [you need to include assessment of this foot ulcer in this part of the diagnostic statement]. this diagnosis will have nursing interventions that have to do with the care of the foot ulcer. the ineffective tissue perfusion diagnosis will have interventions designed to maximize the circulation the patient does have left in his right lower limb. web pages: [color=#3366ff]ineffective tissue perfusion specify type: renal, cerebral, cardiopulmonary, gastrointestinal, peripheral and http://www1.us.elsevierhealth.com/me...ex.cfm?plan=55 and [color=#3366ff]impaired skin integrity and http://www1.us.elsevierhealth.com/me...ex.cfm?plan=48

    the wife and the patient express a desire to learn, so i think a more appropriate diagnosis would be readiness for enhanced knowledge, diabetes disease management r/t unawareness of available resources aeb wife's statement of expressing an interest to learn more and patient's statement that "i know my condition has been taken care much more here than by myself at home." for this diagnosis you institute your teaching plan. web page: [color=#3366ff]readiness for enhanced knowledge (specify). you can find all kinds of information on diabetes and it's management at these websites:
    i would print out one or two of the teaching pamphlets that might apply to your patient and attach them to your care plan for your instructor to see.
    that, kiddo, is 4 nursing diagnoses from the information you provided. the next step, step #3, is to develop your goals and nursing interventions. they are based upon the symptoms which are the things following the aeb part of each nursing diagnosis. i've inserted online nursing diagnosis pages (the links in blue) that have outcomes and nursing interventions where i could to help you out with this part of the care plan.

    don't apologize for your language. just keep working on it. i have been around chinese people from hong kong for most of my life and i was married to a chinese man. i took the time to understand their english. my cantonese is probably worse than your english! my in-laws just outright laugh at me sometimes when i try to speak to them in their own language. i don't know which is worse: having people laugh at you or look disgusted when you try to speak with them. i'm beginning to think i should just learn sign language!
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    i have a pt with esrd and i was wondering if i could use fluid volume excess as a nursing diagnosis but she does not manifest any signs of FVE like bounding pulse instead she has 60 bpm. can i use FVE as a nursing diagnosis?
  4. 1
    Quote from lash_18
    i have a pt with esrd and i was wondering if i could use fluid volume excess as a nursing diagnosis but she does not manifest any signs of fve like bounding pulse instead she has 60 bpm. can i use fve as a nursing diagnosis?
    if the patient doesn't have any symptoms of fve then you can't diagnose her with it. think about this. a doctor wouldn't diagnose you with something like congestive heart failure if you didn't have any of the symptoms of it. so, you can't do the same. any diagnosis is based upon the symptoms the patient has.

    a care plan starts with the assessment you do of the patient. from your thorough assessment, abnormal data (symptoms) will become apparent. the care plan is nothing more than problem solving. the problems are based upon the patient's symptoms. the nursing interventions are aimed at the patient's symptoms. the medical diagnosis (in this case esrd) is not particularly relevant except that you should look up the signs and symptoms of esrd to see if you missed any of them in your own assessment of the patient. fluid retention and a bounding pulse are not the only symptoms of esrd!

    there are two threads on the student forums to help with writing care plans and you will get better responses if you post care plan questions in a new thread on the student forums.
    lash_18 likes this.
  5. 0
    Daytonite Rocks!!!!!
    :dncg:

    so listen up.......

    Tres
  6. 0
    thanks..


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