I need help with NANDA diagnosis for pt. with bacteremia from Campylobacter Jejuni

  1. 0
    I have been through my NANDA book and googled different sites looking for different things to concentrate on to develop my care plan. My pt. did not have diarrhea, but so far that's what the common symptom has been online. My pt. also had a hx of diabetes mellitus, hypothyroidism, hypertension, nephropathy, neuropathy, GERD, thrombocytopenia, and retinopathy. Labs were mostly normal except creatinine was elevated slightly to 1.6; WBC was 4.4; RBC was 3.49; Hgb was 10.0; Hct was 29.9; platelets were 97. The labs aren't making much sense to me except for the elevated creatinine due to the nephropathy. I feel like I'm missing something or not thinking deep enough. I've been staring at my paperwork for a few days and am still drawing blank. Any ideas or advice would be extremely helpful! I can provide more info about my pt. if needed also.

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  2. 9 Comments...

  3. 0
    Welcome to an! The largest online nursing community!

    We are happy to help with homework but we won't do it for you. What do you have so far so I can see what your thought process is? What semester are you so I can better guide you? Did you spend any time with this patient? What were the patients complaints? Remember that your care plan is the plan of care for that patient. A recipe on what you need to think of, and do, for this patient. What did the patient say?what other considerations are there? What was assessment/interaction during your time with the patient? What symptoms did this patient present with?

    The biggest thing about a care plan is the assessment, of the patient. not just physical assessment......but what the patient says, feels, interacts with their environment/family. the second is knowledge about the disease process. First to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms.

    The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. The medical diagnosis is what the patient has and the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

    Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

    Think of them as a recipe to caring for your patient. your plan of care.

    Every single nursing diagnosis has its own set of symptoms, or defining characteristics. They are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

    Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what NANDA calls defining characteristics.

    Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

    1. assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
    2. determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
    3. planning (write measurable goals/outcomes and nursing interventions)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
  4. 0
    Tell me about your patients complaints and presentation to the hospital. What is bacteriema? How does it affect the patient? What do they need? What will help them get better.
  5. 0
    I wasn't wanting anyone to do my homework for me, just looking to see if there was a general diagnosis for that particular bacteria so that I could create my care plan. I also didn't know if there was a maximum length for my original post so I tried to get the pertinent info out there.

    The pt. was brought into the hospital after a blood culture showed up positive. I had this one pt. for 12 hours so he was my only focus. The pt had a round, tender, distended belly with BS present x 4 quadrants. He was running a low grade fever in the 99's all day. The pt. is on narcotics normally at home for chronic pain d/t his neuropathy from DM so he claims that constipation is normal. The pt. had one very loose stool during his stay, but not enough characteristics to call it diarrhea. The pt. was on a full liquid diet the evening before, but was upgraded to 4-carb diet for breakfast. Before the culture came back, a small bowel obstruction or impaction was suspected. The pt. ate 100% breakfast. I came into the room to deliver morning meds and he was sitting at the side of the bed, moaning, holding his stomach, grimmacing, and complaining of severe pain, 9/10. He denied feeling nauseous at the time and said it was just a sharp pain. My instructor and I completed a focused assessment and then we went on to give morning meds. The pt. took all of his meds then attempted to go to the bathroom. He did have two very small drops of stool which gave him a little relief. The pt stated at this point that he almost didn't want to eat anymore because the pain was so bad.

    That was the only data plus the lab values that I was able to gather on him concerning any GI issues.

    Shortly after this, the culture came back with Campylobacter Jejuni. I was able to study that bacteria a little bit and its pathophysiology and it helped explain some of the symptoms he was portraying.

    My focus leads to Impaired Nutrition, but I'm not sure if that is adequate for him? And, I haven't had to create a diagnosis using the AEB feature until now and feel stuck. I want to say Impaired Nutrition r/t loss of appetite from pain AEB pt grimmacing, holding stomach, and stating, "I don't want to eat anymore. It hurts too bad."

    Is that even usable??
  6. 0
    Quote from jringer
    I wasn't wanting anyone to do my homework for me, just looking to see if there was a general diagnosis for that particular bacteria so that I could create my care plan. I also didn't know if there was a maximum length for my original post so I tried to get the pertinent info out there.

    The pt. was brought into the hospital after a blood culture showed up positive. I had this one pt. for 12 hours so he was my only focus. The pt had a round, tender, distended belly with BS present x 4 quadrants. He was running a low grade fever in the 99's all day. The pt. is on narcotics normally at home for chronic pain d/t his neuropathy from DM so he claims that constipation is normal. The pt. had one very loose stool during his stay, but not enough characteristics to call it diarrhea. The pt. was on a full liquid diet the evening before, but was upgraded to 4-carb diet for breakfast. Before the culture came back, a small bowel obstruction or impaction was suspected. The pt. ate 100% breakfast. I came into the room to deliver morning meds and he was sitting at the side of the bed, moaning, holding his stomach, grimmacing, and complaining of severe pain, 9/10. He denied feeling nauseous at the time and said it was just a sharp pain. My instructor and I completed a focused assessment and then we went on to give morning meds. The pt. took all of his meds then attempted to go to the bathroom. He did have two very small drops of stool which gave him a little relief. The pt stated at this point that he almost didn't want to eat anymore because the pain was so bad.

    That was the only data plus the lab values that I was able to gather on him concerning any GI issues.

    Shortly after this, the culture came back with Campylobacter Jejuni. I was able to study that bacteria a little bit and its pathophysiology and it helped explain some of the symptoms he was portraying.

    My focus leads to Impaired Nutrition, but I'm not sure if that is adequate for him? And, I haven't had to create a diagnosis using the AEB feature until now and feel stuck. I want to say Impaired Nutrition r/t loss of appetite from pain AEB pt grimmacing, holding stomach, and stating, "I don't want to eat anymore. It hurts too bad."

    Is that even usable??
    There are those that do come here for homework to be done I just like to remind everyone that we will help lead you to your answer so you can figure it out yourself.

    Your care plan will not be based on the particular bacteria causing the illness.......... but by the symptoms that are caused by the bacterial infection on your patient. What caused the MD to do a blood culture? Were there any x-rays done of the abdomen? The bacteria is in his blood not his gut.......or is it in his gut as well? If it is not in his gut.......he probably has a bowel obstruction as evidenced by no stools

    So he is having pain.......very basic alteration in comfort R/T possible bowel obstruction AEB patient c/o severe abd pain and holding stomach.

    YOU could say at risk for impaired nutrition R/T decreased intake AEB pt stating he "almost didn't want to eat any more. (because he has eaten 100% of the meal)

    What else would a patient with bactermia have.....a Temp? If he has a bowel obstruction what would that cause? Are they getting anti-biotics? Was a stool specimen done? Was there anything else that patient needed? What learning/teaching does he need? Is his liquid intake sufficient? Dehydration can cause an elevated Creatinine so can diabetes. How well controlled are his sugars? Are they compliant with their medical regime?

    See where I'm going?
  7. 0
    This may help....you have to register to see but medscape is free

    Campylobacter Infections Medscape: Medscape Access
  8. 0
  9. 1
    Thank you so much for your help! I wasn't trying to be nasty about my first reply with the homework help thing. I wouldn't ask anyone to do my homework, but I could see how others would and I didn't consider that fact right away. I was able to come up with four diagnoses for my patient!
    Esme12 likes this.
  10. 0
    All good....I hang out here and help students...ask anytime.....
  11. 1
    "I wasn't wanting anyone to do my homework for me, just looking to see if there was a general diagnosis for that particular bacteria so that I could create my care plan."

    No, no, no. It's a very common misconception that there is a list out there that says "For Medical Diagnosis A, there follows Nursing Diagnoses 1,2,6, and 7." Not true, and totally shortchanges the nursing profession's ability to assess and diagnose.

    Please look at your NANDA-I 2012-2014 (ever student should have one) and locate the symptoms you have identified by your patient assessment. Those are called "defining characteristics" for the nursing diagnoses.

    Medical diagnosis isn't the nursing diagnosis. But it can be a defining characteristic; if you have looked in your NANDA-I 2012-2014 you will see quite a few nursing diagnoses with one of the defining characteristics = "disease process."


    This does not mean that there is a magic list of medical diagnoses from which you can derive nursing diagnoses. Nothing is farther from the truth.


    Yes, experienced nurses will use a patient's medical diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment.


    For example, if I admit a 55-year-old with diabetes and heart disease, I recall what I know about DM pathophysiology. I'm pretty sure I will probably see a constellation of nursing diagnoses related to these effects, and I will certainly assess for them-- ineffective tissue perfusion, activity intolerance, knowledge deficit, fear, altered role processes, and ineffective health management for starters. I might find readiness to improve health status, or ineffective coping, or risk for falls, too. I might learn that the patient has sexual dysfunction. These, and many, many others, are all things you often see in diabetics who come in with complications. They are all things that NURSING treats independently of medicine, regardless of whether a medical plan of care includes measures to ameliorate the physiological cause of some of them. But I can't put them in any individual's plan for nursing care until *I* assess for the symptoms that indicate them, the defining characteristics of each.
    KelRN215 likes this.


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