Help please! I have a concept map due tomorrow and I am stuck.
My pt. is a 79yr old Caucasian male. His admitting diagnosis was cellulitis, dependent edema, renal insufficiency, and chronic thrombocytopenia. Has a history of acute renal failure, anemia, disuse myopathy, gout, HTN, and hyperkalemia.
WBC 2.2 (normal range 4.8-10.8)
RBC 2.19 (4.7-6.1)
Platelet 33 (130-400)
Hgb 7.7 (12.6-17.4)
Hct 22.4 (37-57)
MCV 102 (80-94)
MCH 35 (27-31)
Vitals: T 97.1-99.7, HR 73-93, RR 18-20, O2 93-98, BP 117/54-126/72
Non-pitting edema, 1+ right foot. Pt. states that symptoms(pain) are made worse when standing. Redness and swelling present in both feet.
My pt. received 1bag of PRBCs and 2 units of platelets. He tolerated it well. VSS.
I don't know where to start or how to prioritize my nursing diagnosis'. So far I have:
-Risk for infection r/t inadequate secondary defenses to anemia.
-Risk for impaired skin integrity r/t inflammatory process damaging skin
-Ineffective tissue perfusion: peripheral r/t edema
Someone please help me get on the right track and to come up with some more nursing diagnosis'! I am stumped for some reason.