I am having a brain block. I hope ya'll can help.
I had a pt. who was severely anemic. She got 4 units of blood, one of which I personally gave. She is chronically anemic. She got 4 units of blood just one month ago. She is in her late 80's. She had a pos. stool guiac test on my DOC. Now what are my 2 top nursing diagnosis.
She had no S&S of O2 difficulty, Heart rate WNL, good appetite, capillary refill WNL, no edema.
I have come up with Altered Protection, Impaired tissue perfusion, Fluid volume deficit.
Please help if you can!!!
Feb 22, '02
Altered Protection? THats a new one for me. You can add risk for injury r/t altered mobility, fluid & Lyte imbalance, KNowledge deficiet (which i hate and wil NEVER use) hard to thinkup anymore since once you get out of school you really don't use them
Feb 23, '02
Chronic anemia is a major cause of morbidity among the end-stage renal disease (ESRD) population. Recombinant erythropoietin (rHuEPO) has been recognized as a major advance in the treatment of anemia among the ESRD population.
Use of and response to rHuEPO therapy among severely, moderately, and mildly anemic patients. Between 1990 and 1996, the mean rHuEPO dose increased by 139% for the patient cohorts with a first observed hematocrit <0.25, 122% for the 0.25 to 0.29 cohorts, and 107% for the>=0.30 cohorts, and produced a 0.02 to 0.03 increase in achieved hematocrit over this time. Dosing of rHuEPO did not appear to be influenced by patient or provider characteristics, although African-Americans, the elderly, non-diabetics and persons receiving dialysis in a non-profit facility had a larger percent change in hematocrit compared to their counterparts.
Feb 23, '02
Other than her anemia she is in pretty good health. I have no other labs re: her renal function. Because she is so chronic they just ran a CBC.
According to my NANDA book altered protection is a Dx that covers a multitude of problems like age, nutrition, abdormal blood profiles, etc. I guess it is like a catch all.
I think I am going to go with Risk for infection (lives in LTC, decreased H&H, age, etc.) I also think I am going to go with Risk for Impaired Gas Exchange due to her age and severe anemia.
I NEVER use Knowledge Deficit, it is just too hard to do and can get you in trouble with your paperwork in school.
Thanks for the help!!!
Feb 24, '02
I think you are right on the money with Risk for infection and Risk for impaired gas exchange. Iv'e been out of school a couple years but I also think that chronic anemia can put one at risk for athero or arteriosclerosis? It affects perfusion in some way I know. So that may be an additional one you may investigate.
Feb 24, '02
Risk for injury r/t transfusion (potential for reaction, iv site etc)
also r/t low Hgb (dizzy etc.)
also r/t hosp enviorn.
also r/t anthing else that applies to this specific pt
as for those already mentioned
Risk for infection was also a good choice.
Your "fluid volume deficit" was not well backed up in my opinion
risk for impaired tissue perfusion is a possibility. impaired gas exchange is not. according to Carpenito. ( I have the BIG Carpenito has more info than the smaller versions of her book)
Feb 24, '02
not to be outdone, hypovolemia, fluid imbalance, what is the cause of tha anemia, even though she is chronic one would have to assume there is probably an element of renal failure involved, look at her meds what is she taking and why. Try also altered tissue perfusion related to decereased oxygen carrying capacity of the blood, actviity intolerance related to decreased oxygen capacity of the blood, altered nutrition, less than body requirements related to reduced intake of iron, some of these have been mentioned. |Is this lady receving EPO or other substances. I agree with Agnus is relation to hospital envirnoment and transfusion reactions. Remeber NCP are formulated according to priority and should be systematic where possible. I have found the Lippincott manual of Nursing Practice to be helpful (7th edn). I would be concentrating on the cause of the anemia even if it is chronic, has this pt got chrohns disease, if so the nutrition is an issue as diet may exacerbate her symptoms. It is difficult to decide unless you have more clinical information, but I always work on the ABC's then everything from there, good luck and if it is any releif you don't use them once you leave uni. (well not very often)
Must Read Topics