I am doing an assignment for a virtual patient and am having trouble connecting the dots to come up with the correct DX. We are suppose to include the top 2 priority DX and my instructions say DO NOT use Risk for or knowledge deficit for your DX. Please help...am I thinking along the right lines here...or what am I not considering that I should be??
Please pick apart my analysis...criticism welcome!!!
My patient is a 7 mo. old that presents with the following:
Mucousy Diarrhea x 4 days
Abnormal labs as follows:
CO2 19 low
WBC 10.5 High
K+ 3.2 low
BUN 29 High
BM positive for rotovirus, slightly acidic
UA Spec. Gravity 1.028 high
Mother appears anxious and frightened. Pt. is anxious and frightened.
slight reduction in skin turgor.
Appears pale, lethargic, hyperactive bowel sounds, abdomen soft.
Doctor has diagnosed as moderately dehydrated.
I'm pretty sure about this one:
Deficient fluid volume r/t active fluid volume loss aeb BUN 29, slight reduction in skin turgor, UA Spec. Gravity 1.028
BUT...then what about the DX of Diarrhea r/t viral infection aeb (loose stool? Sounds rather redundant but what else would you use as evidence? LOL)
My biggest concern is about his RR of 38 and CO2 of 19.
Am I correct or not? The CO2 is only 1 point below normal. Does this qualify for Impaired Gas Exchange, if not when does it?? Then, what would I use as the r/t....the viral infection? How can I justify that? I don't understand the medical explanation behind that. My instructor likes the explanation of the disease process rather than the disease itself as the r/t.
So would I say viral invasion or something to that effect....ugh my brain is going bonkers.
OK, then there is
Altered Body Temperature r/t viral invasion (??) aeb t. 101.8F
and when does this become priority over fluid volume deficit?
Last but not least there is the NANDA DX of Anxiety, but that won't be priority over these.
There is also concern about the K+ but is this because the infection is having an effect on the heart....and the other factors need to be addressed to bring this back into balance? In a case like this, would the Dr. temporarily usually prescribe a K+ supplement in addition...or not (isn't a bad side effect of K+ diarrhea)??
Ohhhh, these care plans
make my Brain hurt!!!!!!!! Can someone PLEASE help me organize my thoughts? Thanks!!!!!