Help with this concept map

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    Pt end stage liver failure, recurrent pleural effusions with pleural drain. Unstageable decubitus ulcer, diabetes. Need to take two medical Dx, write nursing Dx for each, 2 goals and 3 interventions for each. Problem is pt is now on end of life care. Comfort measures only. No diabetes monitoring, no medications, only draining chest drain for comfort. I am at a loss for enough goals in this case.
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  5. 0
    Quote from LCinTraining
    Pt end stage liver failure, recurrent pleural effusions with pleural drain. Unstageable decubitus ulcer, diabetes. Need to take two medical Dx, write nursing Dx for each, 2 goals and 3 interventions for each. Problem is pt is now on end of life care. Comfort measures only. No diabetes monitoring, no medications, only draining chest drain for comfort. I am at a loss for enough goals in this case.
    Just because there aren't any meds or DM monitoring that needs to be done, that doesn't mean that there's nothing you can do for the patient. Surely you're not going to let the patient lie there and rot away like some fallen log... What can you do to keep the patient comfortable, or do to keep the nursing or medical/technological stuff from contributing to the patient's decline?

    I'm deliberately not giving you answers... but I hope I'm pointing you in a way that you can see things a little bit differently, from another angle, and come up with your own answers!
  6. 0
    I think "comfort" is the key word there. Emotional comfort since death is eminent. Physical comfort. Spiritual comfort. Dying people probably have more needs than the actively living.
  7. 1
    Quote from LCinTraining
    Pt end stage liver failure, recurrent pleural effusions with pleural drain. Unstageable decubitus ulcer, diabetes. Need to take two medical Dx, write nursing Dx for each, 2 goals and 3 interventions for each. Problem is pt is now on end of life care. Comfort measures only. No diabetes monitoring, no medications, only draining chest drain for comfort. I am at a loss for enough goals in this case.
    There is still plenty to do for a dying patient. Just because there are no interventions doesn't mean there is no assessment. Is there edema? How are the mucous membrane in the mouth? Is there mottling? An unstagable decubitis must cause the discomfort. A nurses goal isn't always to cure them and make them well. It is a goal to have Death with optimal comfort. How can you make their remaining time comfortable. Keep them clean and dry. Meticulous oral care. How is the family coping? What happens with end stage liver failure?

    Your goal......is death with dignity. Here are just a few diagnoses that come quickly to mind. even with impaired gas exchange (pleural effusions) how can you increase their comfort? How would you want a loved one care for in the last stages of life. Pull from your personal experiences.

    Impaired Comfort
    Readiness for enhanced Comfort
    Risk for compromised Human Dignity
    Fear
    Impaired Religiosity
    Impaired Oral mucous membrane
    Acute Pain
    Chronic Pain
    Impaired Gas exchange

    http://allnurses.com/nursing-student...nd-218430.html
    http://palliative.info/teaching_mate...tiveClient.pdf
    mind_body_soul RN likes this.
  8. 0
    I highly recommend looking this up in a nursing diagnosis book. The Ackley 9th Ed is excellent.

    Blue
  9. 0
    I have Cox's diagnosis book. Nothing was fitting with the information I had related to her family or her impending death. I guess I didn't ask enough questions. But I had my reasons for that. Right or wrong.I ended up going with impaired skin integrity and risk for infection.
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    Does your school require that nursing diagnosis book? I would consider that you add Ackley: Nursing Diagnosis Handbook, 9th Edition
  11. 1
    Cox is required. I may look into that with the next installment of financial aid.
    Esme12 likes this.
  12. 0
    It's not a great assignment. You shouldn't be creating nursing dx based on medical dx. That doesn't help you, but keep it in the back of your mind.
  13. 1
    Quote from LCinTraining
    I have Cox's diagnosis book. Nothing was fitting with the information I had related to her family or her impending death. I guess I didn't ask enough questions. But I had my reasons for that. Right or wrong.I ended up going with impaired skin integrity and risk for infection.
    I love Esme's suggestions, as per usual. She's awesome! I think what you have chosen is fine though! :-) But, you have to admit that Esme definitely makes you think holistically. In regard to skin---with liver disease, the bilirubin can be very high and cause jaundiced skin. There's itching/pruritis that goes on with that. Benadryl or cortisone can be helpful. Also, ascites happens. This is very uncomfortable for the patient. Remember the liver is a major player in the coagulation of blood. So you would take steps to prevent the pt from bleeding. Liver Disease can also cause altered mental status-- so pt safety is super important and giving a banana bag (thiamine) is very important. I love the idea of thinking about the psychosocial needs and comfort measures that can be done for this patient. Just some other things to ponder on!
    Esme12 likes this.


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