So, now you have another symptom that you want to treat: an elevated white cell count. The first thing you need to do is go back to your knowledge of sciences and ask yourself what might be causing this elevated white cell count? Answer: infection, inflammation, stress, trauma, tissue necrosis or a leukemic process. Looks like the doctor has already determined that it's a UTI. I was also wondering if this UTI is a superimposed infection secondary to all the antibiotics she had been receiving before which would make this a problem of a compromised immune system. In any case, you have another symptom looking for a nursing diagnosis.
I gave you Urinary Retention
for the residual urine or 1000cc. The definition of this diagnosis is "Incomplete emptying of the bladder". So, obviously, an elevated white cell count can't possibly be a symptom of urinary retention, can it? You wanted to use Impaired Urinary Elimination
, but the definition for that is "dysfunction in urine elimination". Not helpful here.
Now, your patient has a UTI. The symptom is an elevated WBC count. What as a nurse
can you do for an elevated WBC count without a doctor's order? Anything? The only thing I can see you doing with this symptom, as a nurse
, is monitoring for signs and symptoms of her infection going into a system-wide septic shock situation. That brings to mind the nursing diagnosis of Risk for Ineffective Tissue Perfusion: cardiopulmonary and renal R/T decreased vascular resistance
[which is what happens in cardiogenic shock due to sepsis]. Don't know if your instructors are allowing you to use "Risk for" diagnoses. The symptoms of this kind of septic shock that you would be monitoring her for would be:
- flushed skin
- altered level of consciousness manifested as agitation, irritability or shortened attention span
- rapid shallow respirations
- urine output the drops below normal parameters
- rapid, bounding pulse
- elevated blood pressure
And you would develop nursing interventions and goals based upon these potential symptoms.
And, that's about all I can see you doing with an elevated white cell count. Or, you could ignore it because you really can't perform any active nursing interventions for it. Point I am making is that just because there is a symptom doesn't necessarily mean that you have
to do something about it. Sometimes there are things that are outside our scope of practice or beyond our control. If your instructors are saying you have
to address every symptom, then I would do it as I've done above.
Let me clarify with you that COPD is a general term used to describe a variety of conditions that result in obstruction of the airway. This is why NANDA allows the use of it as a related item in nursing diagnostic statements. It is not a good medical diagnosis for the doctor's to use. And, what you and many nurses don't know is that the billing departments will get after the doctors who use this term in their documentation of the patient's discharge diagnoses
and they will inservice the doctors. If the doctor's don't specify what the underlying cause of the COPD is, the hospital could loose big time money when they bill for the services that were provided for the patient. COPD is either:
- chronic obstructive bronchitis
- chronic obstructive asthma
- chronic bronchitis with emphysema
The pathophysiology, symptoms and treatment of each is different although there may seem to be some similarities.