Hi so I need to create a concept map with 3 primary concerns relating to my patient. I've got 2 done completely and I think they are good, but i'm just really struggling to come up with a third nursing diagnosis. Could anyone give me some ideas? Let me tell you guys a little bit about my patient for starters:
32 year old male in the hospital on a cardiac floor for currently 7 days for a diagnosis of bacteremia after his LVAD reinsertion - had positive blood cultures. Contact precautions.
Has a history of non ischemic cardiomyopathy following a heartmate II implant in 2010. In addition he has had an LVAD pump infection previously as well.
All vital signs were stable and normal.
No edema and his sternal incision sights looked clean.
Platelets are slightly low
Hgb & hematocrit slightly low but not significant
urinates and bowls fine
up ad lib
So, what I have so far is:
POSITIVE BLOOD CULTURES (admit diagnosis)
Nanda #1: infection
AEB: microorganism invasion in blood, fevers of 101 or higher upon diagnosis.
NIC: Maintain a clean environment, monitor vvitals, inspect wound sites for infection, monitor blood labs such as WBCs for worsening in infectious state.
NOC: Negative blood cultures & WBC count returns to normal, no fevers.
Nanda #2: Risk for hyperthermia
AEB: temps of 101 upon admission, having coolness and chills.
NIC: monitor vitals q6. Administer fever reducers in order- ie tylenol or motrin, provide ice pack upon request.
NOC: keep fevers down, have vital signs continue to be stable at time of discharge
so are those good? what else can I do? I don't consider hypthermia a primary concern but I absolutely couldn't think of anything else...help!!