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 and an AV fistula in the right forearm. You have adminisered her AM NPH insulin at 0730 and you are waiting for her dialysis treatment. At 1130 you do a fingerstick and the results are 236, According to the Sliding Scale you administered 10 units of Regular insulin.
Which of these Nursing Diagnosis is a priority at this time.
Risk for infection
Altered patterns of elimination
Excess fluid volume
Deficient Fluid Volume
Imbalance Nutrition:Less than body requirements
I choose Fluid volume excess, because she is now hyperglycemic. Wouldn't there be a fluid shift from intracellular to intravascular because of the high concentration of glucose in the vascular system.
F&E confuses me...Anyone have any ideas. Thanks
Nov 29, '07
I am on my first semester of nursing school, my pt is on antibiotics and glucoma meds(right eye legally blindness, and hydrochlorothiazide for chronic kidney disease.
His main problem is Diabetic foot unlcer with mycosis, canllus, metartarsalgia and cyst infected on the back.
I have not found the possible Nursing Diagnosis for him, and which make me upset.
Last edit by flyingbaby on Nov 29, '07
And you are going to continue having a problem finding nursing diagnoses for him as long as you keep focusing on his medical problems. Please re-read the information I posted for you on the previous reply. You need to go through your assessment information that you got on this patient from his medical record and from doing your physical assessment. You need to make a list of the symptoms (abnormal data) that you found. It is from that list of symptoms that you will look for nursing diagnoses that have the same symptoms. You need a nursing diagnosis reference to help you do this. You cannot choose nursing diagnoses based upon the medical disease that a patient has. It's like trying to make a square peg fit in a round hole--it isn't going to happen.
Give me a list of your patient's symptoms. I know he is blind and cannot see well. That gives you:
- Disturbed Sensory Perception: visual
- possibly, Risk for Injury
- possibly, Self-care Deficits of some sort, but it depends on what you found during your assessment of his ability to perform his ADLs
What was your assessment of this foot ulcer? What were its measurements? What did the wound look like? Did the nurses already assign a Stage to it (there are 4 stages for skin ulcers)? Was there any drainage present and what did it look like (serosanguinous or purulent)? How much drainage was there? Was there any odor? What is the treatment being done for the ulcer and how often? How bad is the pain in patient's foot? What rating was used to assess it? Is the patient receiving any kind of treatment for the pain? What's going on with this cyst on his back? What is the assessment for it--size, any drainage, treatment for it? Just why is the antibiotic being given to this patient anyway? The doctor would have detailed this in his progress notes. What are the patient's symptoms of his kidney disease? What did his labwork (electrolyte) look like? Any pain in the flank? What was his output like? Does he have any output? Is he on dialysis? What medications is the patient on? Sometimes the medications a patient is on will backtrack you to clues as to what is going on with the patient.
Do you understand what I am trying to do here? You need to investigate what is going on with the patient and why the doctor is ordering certain things. The doctor is treating the patient's symptoms just as you are going to develop nursing interventions for some of the patient's symptoms as well. However, you can't even begin to do that until you figure out what those symptoms are. You have to investigate (assess) first. Then, we can work on nursing diagnoses. The fact is that your care plan and the goals and outcomes are going to be based on these symptoms you find. A nursing diagnosis is nothing more than a label (a name) that you put on the problems that you have found and nothing more than that. Don't get so hung up on it. You need to be clear about what the symptoms are first.
Last edit by Daytonite on Nov 29, '07