You work with what you have. This is a first attempt, right? Based on the information you did have I was able to come up with four nursing diagnoses for real problems. That is one more than what you needed. The patient was made NPO because of the risk of aspiration if she was having swallowing problems. If I were you, I'd go with these:
- Impaired Swallowing R/T neuromuscular impairment secondary to Alzheimer's disease AEB difficulty swallowing [I would address this from the situation as it is just being discovered and the patient is being kept NPO. Although you know that a gastric tube hasn't been inserted, I would care plan for the likelihood of IV fluids and perhaps even some diagnostic tests, especially since you don't know much more about what is going on with the patient. Hospice hadn't been ordered yet, so no definitive medical treatment is yet known. So, I would approach this as strictly a patient with a swallowing problem, what are we gonna do about it, what can we anticipate might be done about it]
- Impaired Physical Mobility R/T contractures in arms and legs AEB [bedridden? can only walk with assistance?]
- Chronic Confusion R/T Alzheimer's disease AEB disorientation to person, place and time that has been increasing over time
By talking to the sister you got some good information and that was excellent. You did good, Grasshopper!
As for the renal failure. . .she's going to have that and other organ failures as she begins the process of dying. End-of-life care is a little new for some people and somewhat emotional too. We used to do code blues and keep people alive on life support until there was just nothing left of them. It was, however, at the end of it all, fruitless. The newer thinking is to do what is going to be done for this patient--allow her to die with only comfort measures. Eventually all her various body systems will break down and go into failure and she will pass away. The care plans
for patients like this are mostly involving comfort care, self-care deficits and coping strategies for the patient and family. Books and articles about hospice and end-of-life address these issues. It seems to be contrary to what the health professions promise to patients, but it really isn't. We are just honoring their wish not to prolong the breakdown of their body, but to provide comfort as it proceeds.