Need urgent Help on assignment Pt care plan!! please! im so stuck!

1. 63 year old lady, history includes cancer of the bowel 6 years ago resulting in a colostomy and until this admission patient has been self caring with the stoma. Cancer has progressed and patient is admitted for re-hydration and palliative care. patient and has ordered that a nasogastric tube be inserted and nasogastric feeding to commence,. the medical officer has also ordered an indwelling catheter be inserted - with hourly urinary measures.
   
   1. 3 nursing diagnoses and 3 nursing interventions
   2. Discuss how a nurse you would demonstrate how you could support and encourage the patient to exercise their rights and personal choices as they approaches end stage care.
   
   I just cant seem to get this.. I have a diagnosis such as ( Risk for impaired skin integrity related to fecal drainage and pouch adhesive )? (risk for deficient fluid volume related to dehydration) ??
   Please help!!
   
   
   
   
   
   

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2. 9 Comments

   Comment
3. 
   Jul 29, '11

   What exactly are you stuck on? This patient has a lot going on so it should be easy to find a minimum of 3 nursing diagnoses. Think about what is going on with the patient, physiologically and psychosocially. Do you have a care plan book? Or a list of nursing diagnoses? Scan through those to help.
4. 
   Jul 29, '11

   Ok. First step.....calm down.
   Once you have completed the first step, it's all downhill.
   She does indeed have a lot going on, so as hiddencat said, just look at your list of nursing diagnoses and ask yourself could this apply? I used to check off all that would apply and then pick the top 3 (or however many).
   
   Almost every patient has a knowledge deficit. Think about not just medical interventions, but her psychosocial status as well. I guarantee that you can find three easily.
5. 
   Jul 29, '11

   what if this were your mom in the bed? what would she need for care, comfort, support, knowledge to make decisions? make it a real person, and when you pull out your handy-dandy nanda 2009-2011 book (get this!) and scroll down the list, you'll be all set.
6. 
   Jul 29, '11

   This assignment sounds PAINFUL. Maybe a little SUPPORT would be helpful? Make sure you DRINK AND EAT well or it may have very serious consequences. And I agree, a little EDUCATION goes a long way. GL
7. 
   Jul 31, '11

   For me when I hear "indwelling cath" I think ...Risk for infection.
   
   Knowledge deficit... hydration.
   
   that's all I got on this one...others have covered it..
8. 
   Jul 31, '11

   Knowledge deficit for the hydration? Not sure if you can go that far without seeing the patient. It might not have been a knowledge related issue for the patient that led to the dehydration.
   
   Risk for infection is good.
   
   Think about your ABC's!
   
   Since the NG tube is there how about Risk for Aspiration?
9. 
   Aug 1, '11

   Thank you to everyone for all your help! really do appreciate it!
10. 
    Aug 1, '11

    Palliative care..........cancer. HELLO!?!?!? Pain should definitely be one of your primary focus. Pain managment in this case is HUGE!! Also, this gives the patient some control over how she is feeling.
    INTERVENTIONS:
    -Educate patient on taking pain meds before pain escalates. Give reasoning for this.
    -Use scale 1-10 and 30-45min after administration rate pain again to ensure adequate control
    -Encourage non-medication pain control (deep breathing, distraction, etc)
    You get the idea.....Pain managment is often times a primary focus for our patients because it is difficult to worry about skin integrity and nutrition when they are crying due to the pain. Plus pain is considered a 5th vital sign, right?
11. 
    Aug 1, '11

    I would address the fact that this patient is moving into end stage care, comfort care, while the doctor is ordering invasive and uncomfortable interventions that will prolong life. For what purpose? To what end?
    
    How about: Risk for compromised human dignity?

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