Nursing Diagnoses Help!
- 0Sep 13, '09 by b_howardI have a dying patient, and I have to come up with 2 priority nursing diagnoses, 5 goals (for each diagnosis) and 5 interventions for each goal. The main medical diagnosis is renal insufficiency, this patient isn't expected to live many more hours. This patient has also been diagnosed with hyperkalemia and CHF. Assessment wise, this patient is listless, and lethargic, the pulse is strong and regular the heart sounds are irregular, there is edema in both arms, respirations are shallow and irregular there are expiratory wheezes in both lungs and at 10 breaths per minute.
I'm not very good with nursing diagnoses, especially for a dying patient. I've thought about something along the lines of comfort measures or knowledge deficit (for the family). If there is anyone out there that could help, it would really be appreciated.
- 0Sep 14, '09 by KAYBDT6
- 0Sep 14, '09 by Daytonitenursing diagnoses, which are merely names for the nursing problems the patient has, are always based upon the signs and symptoms of these nursing problems that the patient has. therefore, they are dependent on the nurse having done a thorough assessment of the patient.
i usually approach care planning from a nursing process viewpoint, but with a dying patient, in particular, the nurses overall goal is to support the deterioration of the patient's condition. that doesn't always sit well with some people, but there it is. nanda doesn't really have a nursing diagnosis for this, but there has been one that has been used unofficially for a long time. i don't know if your instructors will allow it, but i will provide it for you for your consideration and you can run it by the instructors and see if they will let you use it.
- impaired comfort r/t physical deterioration aeb listlessness and lethargy - and any other observations you remember that the patient seemed in discomfort, uncomfortable or restless
- irregular heart rate
- respirations are 10, shallow and irregular
- expiratory wheezes in both lungs
- edema in both arms
- decreased cardiac output r/t altered heart rate and rhythm and elevated potassium levels secondary to chf and hyperkalemia aeb irregular heart rate and peripheral edema in arms
- ineffective airway clearance r/t retained secretions aeb respirations of 10 that are shallow and irregular with expiratory wheezes in both lungs
as far as doing knowledge deficit (for the family) i wouldn't advise that with the physical evidence that you do have on the patient. the focus of a care plan is always about the patient--not the family. when you start turning to the family you still need to make the patient the focus. and as i started out, although it is uncomfortable, there are a lot of things we can do to support the deterioration of someone who is dying. i worked in long-term care and took care of many dying patients. they shouldn't get swept under the rug because they are at the end of their days. see these weblinks for ideas for care of dying patients:
- 0Sep 14, '09 by KellT1203Another tip which might be helpful, you can use this for this patient and other patients. I like to look up ther clinical diagnosis in my nursing diagnosis book and then go from there. The nursing diagnosis book will give some nursing diagnoses for that particular clinical diagnosis. I find that I can tweak what the book says so it follows along with what my patients symptoms are. It helps me out a lot.