Help I need a nurs diagnosis

  1. I have to do a careplan and maslow for my pt that is 32 with leukemia. He was told in nov 06. He came in with temp and headaches he is fine now and is going home soon. His wbc's were low but are high now. He seems to know about all about his leukemia and is coping well. I was going to pick risk for infection but don't I have to have and actual diagnosi if its going to be my primary one. Any suggestions would be great. I hate these things.
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  2. 9 Comments

  3. by   mommapunkin
    does he have any breaks in his skin anywhere? Maybe you could do Risk for anxiety? Is he overweight/underweight? You could do imbalanced nutrition:more/less than body requirements. Im trying to think of more but am coming up with nothing. Tell me a bit more about the pt and ill try to help.
  4. by   rn-in2008
    That's my problem there really is nothing else wrong with him.He is on a lot of pain meds and slpeeing meds.He is a little overweight but with the Leukemia that is not that bad. He did just have his gallbladder taken out, so he has some opening there. Iam doing a teaching plan on his diet for that.
  5. by   Achoo!
    How about ineffective protection r/t abnormal blood profile?

    Risk for infection r/t ineffective immune system?

    Those are right out of my Ackley book.
  6. by   Nurseonwheels
    ok let's see:

    Potenital for depression due to diagnosis

    knowledge deficit related to medication regimen

    Sleep pattern disturbance

    Potential or actual pain

    Does he have a line or a port?

    Potential for infection

    Knowledge deficit related to care of port

    Just a few
  7. by   brighella
    i like ineffective protection (good for blood and immunity disorders) (and risk for)

    Our professor said that if there isnt anything acute w/in a system, risk for diagnoses are ok
  8. by   rn-in2008
    I was going to pick ones of these ineffective protection r/t abnormal blood profile, Risk for infection r/t ineffective immune system. I have to make sure it is the highest priority according to maslow. I don't think I could use risk for as the main one.
  9. by   Daytonite
    Was this person in the acute hospital? Why? What were the symptoms listed in his history and physical by the doctor? He cannot be totally fine if he was admitted to the hospital. There was a reason he was there. There are also wellness diagnoses that you can use if you can find absolutely nothing else (they being with "Ready for enhanced. . ."). There is always a need for knowledge and facts, that is at the very top of Maslow's pyramid (self-actualization). http://en.wikipedia.org/wiki/Maslow'...archy_of_needs
  10. by   rn-in2008
    thanks everyone.
    I am going with risk for infection. He was admitted for high temp and low WBC 0.3. But that is now taken care of.
  11. by   Daytonite
    This is just my opinion. I think your instructor is not going to happy if you don't address A problem of some sort with your care plan. A "Risk for" diagnosis is only a potential for a problem that could never exist. May I suggest that you consider these after doing some investigation of the pathophysiology of leukemia:
    • Ineffective Thermoregulation R/T chronic illness AEB fluctuations in body temperature above and below normal ranges
    The regulation of body temperature is one of the major physiological mechanisms of the body and a one of the presenting symptoms that people with leukemia get as a result of what is going on with their immune system. I think you would be wrong not to address this in a care plan.

    Another nursing diagnosis you can use would be:
    • Readiness for enhanced Therapeutic regimen management
    • Readiness for enhanced Knowledge of disease process
    http://www.cancer.gov/cancertopics/wyntk/leukemia - "What You Need to Know About Leukemia" from the National Cancer Institute
    http://www.nlm.nih.gov/medlineplus/e...cle/001299.htm - leukemia
    http://www.medicinenet.com/leukemia/index.htm - leukemia links Medicine Net
    http://www.medicinenet.com/leukemia/article.htm - Leukemia (on Medicine Net)
    http://www.webmd.com/cancer/tc/Leukemia-Topic-Overview - Leukemia on WebMD
    http://www.cancer.gov/cancertopics/alphalist/l-m - National Cancer Institute links to the various types of leukemia
    http://www.nlm.nih.gov/medlineplus/e...cle/003090.htm - fever

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