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!