MomBak2Skool 2,248 Views
Joined Feb 14, '11.
Posts: 439 (2% Liked)
Actually, now I'm second guessing myself. "Electrolyte imbalance" isn't a REAL NANDA diagnosis...it's actually listed as "Risk for electrolyte imbalance". So I'm not sure if I should use electrolyte imbalance as a diagnosis. Maybe I can use it as part of my fluid volume excess diagnosis? I feel like I should mention it because it's an out-of-range potassium level which can have extreme consequences on the heart but I don't want to just "make up" a diagnosis that's not NANDA-approved. And this way, I can still include impaired skin integrity like I originally wanted to! Thoughts?
I think you got them..well done! I would include renal failure as well as there is clear evidence of this in the labs. To prioritize think about what can hurt them first....I have to make dinner....but I''l be back. Is this to be based on all the diagnosis that you can find for this patient?
Thank you so much for your responses! Esme12...do you mean I should include risk for ineffective renal perfusion? What other NANDA diagnoses could be used for renal failure (besides the excess fluid volume that I already used)? Or should I just add renal failure to my electrolyte imbalance diagnosis like hodgieRN suggested? For example, I could put: "Electrolyte imbalance r/t ascites, continuous peritoneal drain, and renal failure aeb hypokalemia and elevated BUN and creatinine levels."
We have to list as many diagnoses as we could come up with for our patient and then pick the top 3 priorities to develop a care plan for. Thanks again for the help! I really appreciate it
My patient is an 80yo M with a history of HTN, DM, cirrhosis secondary to Hepatitis C, blindness, and dementia. He is hypokalemic (3.3) and thrombocytopenic (26,000). BUN is 84, creatinine is 3.5. Low eGFR, low INR, high PT. Vitals are normal except for high RR of 22 and high BP which he takes Norvasc for. Blood sugar was below 150 (so no coverage) both mornings I cared for him. He is Islamic and speaks no English. His son translates for him but is not always around. No history of tobacco, alcohol, or drug use. He is on bedrest; has a peritoneal drain and a condom catheter; is incontinent of stool; has skin tears on his forearms, tops of thighs, and buttocks. He is very skinny but eats all of his food (Kosher). He is DNR. Discharge planning included hospice care but the staff was fairly certain his family would not agree to that and would want to take him home so plans were made to send him home with the peritoneal drain and possibly the condom catheter as well. So far my nursing diagnoses are:
1. Risk for bleeding r/t thrombocytopenia (platelet count of 26,000)
2. Bowel incontinence r/t dementia aeb inability to recognize the urge to defecate.
3. Urinary incontinence r/t dementia aeb uninhibited urination at unpredictable times.
4. Impaired dentition r/t self-care deficit aeb excessive plaque and missing teeth.
5. Electrolyte imbalance r/t ascites and peritoneal drain aeb hypokalemia.
6. Ineffective breathing pattern r/t pressure of ascites fluid on diaphragm aeb tachypnea.
7. Fluid volume excess r/t cirrhosis of the liver aeb ascites and pitting edema +1 in the lower extremities.
8. Impaired skin integrity r/t physical immobility and bowel incontinence aeb skin tears on the forearms, tops of thighs, and buttocks.
Am I missing any important diagnoses?
I can't seem to narrow in on what my top 3 would be (I'm thinking it would be #s 6,7,8 although I think #1 is very important but not sure if I can include a "risk for" in my top 3).
Do I need to elaborate on any of the diagnoses I have listed?
I would really appreciate any and all advice I can get. This is my "big assignment" for my main Med-Surg course (3rd semester) and it's due on Tuesday.
Thank you all in advance for your help!
Also, I have no diagnosis for my Genitourinary assessment. True, he is experiencing anuria as I saw him on Wednesday and he hadn't urinated since the Sunday before. But I looked at the impaired urinary elimination diagnosis and he didn't seem to quite fit that. He also doesn't have urinary retention because his kidneys simply aren't making any urine to be retained. The other diagnoses for elimination include incontinence (No), constipation (No...he had a BM the morning I saw him and says he usually has 2 a day), diarrhea (No), and motility problems (No...he had normal bowel sounds). I'd hate to leave that blank but I also don't want to make something up just for the sake of filling in that one area.
I'm still not happy with that diagnosis. I have others that I need to prioritize. Here are the ones I feel are most important, but I don't know which would be my #1, #2, and #3.
Decreased cardiac output r/t altered stroke volume aeb dyspnea, anuria, crackles in the lungs, cough, and restlessness.
Ineffective airway clearance r/t secretions in the bronchi aeb crackles in the lungs and excess sputum.
Fluid volume excess r/t renal failure aeb dyspnea, crackles in the lungs, pulmonary congestion, decreased Hb/Hct, and restlessness.
Risk for electrolyte imbalance r/t renal dysfunction and effects from cardiovascular medications.
Any suggestions are greatly appreciated
Thanks for the link Streamline! It looks helpful. I came up with this diagnosis...not sure if it's good or not: Ineffective renal tissue perfusion r/t hypertension and renal disease aeb decreased RBCs, decreased Hb/Hct, elevated BUN/Crt, anuria, and fluid overload.
I have a 36 yo patient in renal failure. He's on dialysis, producing no urine, has bronchitis, hypertension, congestive heart failure, is on 2L/min O2 via nasal cannula, and on remote cardiac monitoring. He presented with shortness of breath and headache but is being kept for observation due to his renal failure, bronchitis, and newly diagnosed congestive heart failure. His WBCs are high, RBCs are low, albumin is low, HGB and HCT are low; BUN and creatinine are WAAAY high and CO2 is high. For one of my nursing diagnoses, I want to put that he has ineffective renal perfusion but I have a few questions:
1. NANDA only has a "Risk for ineffective renal perfusion" diagnosis, not an actual ineffective renal perfusion diagnosis. Can I just take out the "risk for" part or would that not be acceptable? Clearly, I think this man is no longer just "at risk".
2. Would it be accurate to have my "r/t" part be hypertension and renal disease?
3. If I do take out the "risk for" part, what would my "aeb" part be? I was thinking about saying "aeb abnormal lab values and anuria; am I missing anything?
So would this be okay?: Ineffective renal perfusion r/t hypertension and renal disease aeb abnormal lab values and anuria.
Thanks so much in advance for any and all suggestions! (P.S. This is my first concept map/care plan due next week and it's a big part of our grade!)
I'm also in an ADN program, finishing up my first semester. We are expected to educate our client within the scope of our knowledge. Basically, anything we've learned so far in lectures and on-campus labs, we should be able to explain to a client. Of course, if they have questions regarding their specific care plan, disease, etc. we still refer them to their RN or doctor. But for a situation such as taking vital signs, as long as you know the normal ranges for BP, RR, temp, etc. (which was one of our first lectures) I don't think there would be anything wrong with saying they are within the normal ranges. If their numbers don't fall within the normal range (after re-checking) I would let the RN know and tell the family you would be more comfortable with the RN explaining any out-of-range measurements.
Thanks brillohead! That makes a lot of sense. Do you know anything about any differences in responsibilities between CNAs in an LTC facility vs in the hospital setting? Or are the responsibilities pretty much the same in both environments?
1 hour for 40 questions; 2.5 hours for our final exam which will be 100 questions
Hi everyone! I've been reading posts for quite awhile and really enjoy hearing all of your experiences! I am a first semester nursing student and have been informed that at the end of this semester (only a month away...yay!) I will be able to get my CNA license just by proving I've passed my Basic Health Assessment class and my Fundamentals of Nursing class with clinical rotations. I definitely want to go for it and get a part-time job while working so I can accumulate some experience. I've already started the job hunting process and it doesn't look like there's much available at the local hospitals (I'm in the DC metro area). The openings that are available want at least 6-12 months experience. I did find some openings at assisted living facilities. I just wanted to know what anyone's suggestions are for working as a CNA while in nursing school. I know that working in these kinds of places (nursing homes, LTC, etc.) can be very demanding, but just how different is it from working as a nurse tech in a hospital? When I become an RN, I definitely want to be in an acute care hospital setting, but I know I have to get my foot in the door somewhere. Will this kind of experience really help me in the long run? Should I wait for a hospital position to open up, or will any experience be helpful? Thanks for any advice you guys have!
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