S.O.S. I need help

[meek69]

Hello, I need help with my care plan. We have had no official help from our instructors so I have been looking online and youtube to try and learn on my own. I was browsing and found this website. Each week in clinical, we have to come up with 5 nursing diagnosis using subjective and objective data. This week, we have to do the rest of the care plan, interventions, rationale and evaluation. So, I have to choose only 1 nursing diagnosis for this careplan and I am not sure how to distinguish which one is more important than the others since they all seem valid. My patient had sepsis to the right knee and had an I & D done. He has a history of HTN, blood clots, and stage 4 CKD. these are the diagnosisi I came up with.

(1) Infection, risk for, r/t introduction of microorganism in the body

Objective data: initial WBC and temp elevated (now down to normal) infectious disease consulted, vancomycin Q24hrs

(2) fluid volume overload r/t insufficient kidney functioning "secondary to" stage 4 CKD AED abnormal labs and findings.

Objective: BUN and creatinine elevated; 2+ bounding peripheral pulses, edema, Intake greater than output, bumex and norvasc ordered

(3) altered tissue perfusion r/t redistribution of blood volume "secondary to" sepsis to right knee AEB swelling of the right leg

Objective: history of blood clots, compression socks; dry and scaly skin on feet; brittle toe nails, coumadine and ASA ordered, DVT precautions

(4) impaired skin integrity, risk for r/t incision from invasive procedure

Objective: patient's age, history of anemia; decrease in mobility; incision to knee; decrease in patient's appetite

(5) anxiety r/t interruption of caregiver role AEB patient takes care of wife that is a nursing home resident

objectives: patient's face sadden and fearful; patient is wringing hands nervously

This is what I have so far, just wanting to know am I on the right track. I was thinking to do the care plan on the infection because it was really bad because they had to remove the entire bursa sac but the infection is under control. That is where I am stuck.

Help, please. Which diagnosis would you use and why?

thanks

meek69