Help w/NCP

  1. Hey, I'm new to the site & I love it so bear with me. I have a question about a NCP for school. I'll be graduating in MAY! Here's the situation:
    49 y/o male admitted over a week ago with End Stage Liver Disease as well as anemia, cirrhosis, sepsis, ascites, pruritis d/t allergic reaction to Lasix, leukocytosis. He's on fluid restriction of which he was reluctant to comply. His labs were all over the place. This guy had a paracentesis on 02/20 to the RLQ for the ascites. His abd was distended and hard. His stools were tarry w/visible blood present. He had pulled is PICC line out and replaced it the day I was there. I have plenty psychosocial ones to address.
    We have to have 4 physiologic NCP's and I'm not sure which one to address 1st, 2nd, and 3rd. I have ideas of individual care plans, but which one would be addressed 1st. I don't know whether to focus on the anemia, spepsis, or the ascites.
    I'm going to thank everyone in advance, I've tryed talking to my instructors. But they don't even want to direct me in the right direction. I'm not asking them to do the care plan, I need help knowing which to address 1st.
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  2. 9 Comments

  3. by   Jolie
    What about addressing comfort measures. If I were that patient, comfort would be my first priority!
  4. by   unknown99
    I am not trying to be mean or anything, and I know how you feel, I've been there. Your instructors did not guide you for a reason. They want you to figure it out for yourself, plus it appears that they have the confidence that you will do so. I will give you a hint though. Think of the A.B.C.'s of patient assessment. What would be the first thing you would assess ANY patient for?
    Well , goodluck, and let us know how you do!!!
  5. by   zacarias
    Man, if that guy is not on the transplant list, he is not long for this world sorry to say!! I look at all of his problems and my first concern would be his bleeding. He's got anemia and tarry stools. Bleeding from GI tract due to Portal Hypertension. Go from there.
    You didn't say anything about his renal function but I bet it's weak.
  6. by   SnowymtnRN
    ABC's. Since Airway, Breathing isn't an issue (yet) then circulation. Since circulation is not the main focus (cardiac) then what's the MOST life altering disease process he's presenting? I'd say ESLD, then ascities. But that's me. Good luck!
  7. by   leslie :-D
    sepsis would be the most urgent one.....the anemias, ascites and other hepatic events are all a part of the bigger picture that will need more intricate planning. ncp's will then depend on whether he is made comfort measures or put on a transplant list. but even in the short term, the anemia and ascites will both impact his breathing, so of course, they too would take priority. good luck.
  8. by   jlynnRN
    Thanks everyone for your advise. I realize remember the ABC's but when you have a vit. k deficiency/hemmorrhage, anemia, & sepsis. Which one should be addressed 1st was the problem. I get so confused with people like this guy, he's got a whole bunch of probs that are all pretty serious. Thanks again.
  9. by   SnowymtnRN
    crap. i missed the sepsis dx. The pp is right, i'd go with sepsis first. lol PREGGO BRAIN!!!
  10. by   leslie :-D
    Quote from jlynnRN
    Thanks everyone for your advise. I realize remember the ABC's but when you have a vit. k deficiency/hemmorrhage, anemia, & sepsis. Which one should be addressed 1st was the problem. I get so confused with people like this guy, he's got a whole bunch of probs that are all pretty serious. Thanks again.
    God, i remember all the anxiety these ncps caused me in school. jlynnrn, try to put it in perspective. his k deficiency and resultant hemorrhaging and other low blood counts definitely impact his breathing, part of the abc assessment. since he's profoundly anemic, he's not getting adequate o2 so that would be a part of your abc assessment since the anemia is clearly impacting his breathing. the sepsis and uncontrolled bleeds are in the top 2 of physiologic priorities.
  11. by   SnowymtnRN
    Yeah they used to totally freak me out too. Not because i didn't understand, but because the darn teachers would just COMB over them with a fine tooth comb and nit pick them to death. Good luck!

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