Hi, I guess I need help with my NDxs if anyone would like to help.
My pt was Dx'd with multiple myeloma, but he was not in pain so I can't include this issue in my care plan. He was anemic and this is indicated in his labwork, but what really stood out to me the most was his swollen feet. His feet were sensitive to the touch, and when I was checking his lower body strength, he was reluctant to push against my hands because it hurt so bad. When I pushed on his feet, he grimaced in pain. He was very mobile, I later discovered, but his feet were so swollen that his skin was shiny and taut while standing. His joints around his toes were red as well, and I noted nonpitting edema that was painful upon palpation.
He later informed me that he will have to stop attending church because the chemo leaves him immunocompromised, he is widowed, and his only family member is his grandson because his daughter is dead.
I figured that I could use these NANDAs: impaired tissue integrity r/t chemical insult (?) secondary to chemotherapy side effects OR r/t cell lysis secondary to chemotherapy aeb feets bilaterally hot and tender to touch, nonpitting edema tender to touch, protectiveness toward site, thrombocytopenia, and reported local and intermittent pain upon palpation of reddened areas.
This is the one that I am having the most trouble with.
The other ones I wanted to do were Nutritional Deficiency r/t malabsorption and decreased intake secondary to treatment side effects aeb reported loss of the sense of smell and reported loss of the sense of taste. However, she did consume at least 75% of her lunch and dinner. She can't eat fresh fruits and veggies, though, so I don't know if this is a good one to use for him despite the fact that this NDx would probably be protocol for all chemo pts.
SO, another one that I was looking into with more evidence would be Impaired Urinary Elimination r/t kidney damage secondary to multiple myeloma and chemotherapy aeb reported daily use of diuretics and pt reporting need to rush to bathroom to avoid incontinent episodes.
Feel free to correct me, I know that my phrasing is probably terrible!!!
My last one would probably be social isolation r/t avoidance of crowds secondary to chemotherapy-induced immunosuppression aeb reported avoidance of crowds and h/o neutropenic isolation
This is my first cancer pt, and he was wonderful. I know what I would implement in my daily schedule when providing care for him, but I am having trouble with his care plan!!!!
Thanks to all who took the time to read my post, regardless of their ability to assist!!!