Giant Concept Maps - My Kryptonite

[Stephalump]

Hello!

I'm struggling putting a concept map together, so once again I defer to the genius found here.

So here's the deal:

25 year old female pt

5ft 6in and 95lbs

Complains of shoulder pain

Admitting Dx: ESRD

Hx: Bipolar Disorder, Septic abortion 5 months ago, Hepatitis C, Antiphospholipid Antibody Syndrome, Polysubstance drug abuse

Patient was alert and oriented to person, but only occasionally oriented to place and time. BP: 141/73, P: 133 normal sinus rhythm, no edema, lungs clear. Creatinine: 4.3. BUN: 67. PT: 12.9. INR: 1.24. Platelets: 122,000. EKG and CT were normal. Non-compliant with hemodialysis and anticoagulant therapy, as well as her medications for bipolar disorder.

Taking Klonopin, Colace, Prozac, Heparin, Protonix, Trazodone, Ativan, and Norco for the shoulder pain.

She was hallucinating, restless, irritable, and confused most of the time, but I did get to have a good talk with her and get my assessment done during a good 90 minute period. She was kicked out of her residence, tried to go to a shelter (was rejected due to lack of money or ability to find a job. Nice.), and ended up going to the hospital. She stated she hadn't been to dialysis in at least a week and she knew she'd be admitted and at least have a place to sleep. She admitted she was using meth up until she was kicked out of the house a couple days before. She said she was struggling to eat due to the dialysis and depression (and the meth, I assume). Has a child in CPS custody that she hasn't been able to get back due to drug use. She says she tried to get clean, but after her septic abortion and kidney failure, the state decided she wasn't healthy enough, so she spiraled back to drugs.

She had a LOT going on and I'm kind of spinning my wheels. I was trying to create a problem list and link my assessments and her comorbidities and tests to the problems, but I'm kind of confused.

Her altered mental status was obviously due to her substance abuse withdrawal. Nursing Dx: Acute Confusion, Risk for Injury

Shoulder Pain - No clue what was causing it. Drug withdrawal? So the only Dx I have is Pain

Hypertension and Tachycardia linked to ESRD, withdrawal, and non-compliance with dialysis. Dx: Haven't gotten that far yet r/t anxiety

Non-compliance with every treatment and drug she needs Dx: Haven't gotten that far yet r/t anxiety.

Am I at least on the right track? Would her homelessness be considered a problem that deserves it's own section? Her chief complaint was the shoulder pain, her admitting Dx was ESRD, but the priority at the time was the drug withdrawal and getting her through dialysis so she could go "home," so should my main focus still be the ESRD????

[Esme12, ASN, BSN, RN]

Wow....Steph.....could you pick a less complicated patient? LOL You are on the right track

When is this due? I am on the run right now but these are a few I can think or right now

Anxiety

Risk for Bleeding

Caregiver Role Strain

Ineffective Coping

Risk for Electrolyte Imbalance

Ineffective Health Maintenance

Hopelessness

Imbalanced Nutrition: less than body requirements

Self-Neglect

Acute Confusion

Excess Fluid Volume or Deficient Fluid Volume

[Stacey73]

And I was struggling with a 60 yr old with pneumonia! Holy crap. I think 2/3 of my class would quit immediately if this was our case.

[shaas, ASN, RN]

Two things stand out for me other than what I've mentioned in the other thread regarding coagulation.

1) If your pt. is not compliant with dialysis and has a change in mental status, a red flag (either a high serum uric acid or ammonia values) should go up. Change in mental status with noncompliant dialysis patient tells me her blood may be full of unwanted metabolic wastes, especially the ammonia.

2) There is a strong correlation between bipolar disorder and fibromyalgia. It can manifest as sensitivity to pressure, translates to pain, or joint stiffness, hence pain in joints. It can also manifest as generalized pain anywhere in the body.

Good luck!

[Stephalump]

Wow....Steph.....could you pick a less complicated patient? LOL You are on the right track When is this due? I am on the run right now but these are a few I can think or right now Anxiety Risk for Bleeding Caregiver Role Strain Ineffective Coping Risk for Electrolyte Imbalance Ineffective Health Maintenance Hopelessness Imbalanced Nutrition: less than body requirements Self-Neglect Acute Confusion Excess Fluid Volume or Deficient Fluid Volume

Goodness gracious, I don't know what I was thinking! I've been working on this thing for 14 hours now. And it's due bright and early tomorrow morning!

Thank you, thank you, thank you! I was in the middle of a panic attack...just a few more ideas calmed me a bit :)

[Esme12, ASN, BSN, RN]

That is ok honey...no worries.....I was on the run to the High School FB game and color guard performance for my kids...I'm glad to help...I could see you got stuck in your head!!!! ((HUGS))