82 y.o. male who came in with c/o chest pain. He was given nitro and fentanyl and given a CXR which revealed cardiomegaly and mediastinal widening with mass like projection. His chest pain is now controlled, and according to the nurse, he would have been sent home if not for the discovery on the CXR. He has + 2 pitting edema both lower extremeties. Hx of CAD, CABG x 3 vessels, a-fib, pacemaker, HTN, PVD, DM2, CKD stage III, anemia. He was given 2 units of PRBS last night as well as 1 unit FFP. INR today 1.45, so he was ok'd for a biopsy (which they let me watch and was way cool). His labs showed anemia. Glucose is uncontrolled, today was 274 in AM, 313 at lunch (this is after being NPO midnight). We held his insulin in AM due to being NPO and he has a rapid response to Novolog with a tendency to drop according to nurse. They suspect lymphoma or lung cancer. When we talked, he went on and on about his family, how he provided well for them, their education, and his excitement of being a great-grandfather in May. He also kept saying, "Just b/c they found something, doesn't mean it is malignant. It may just be nothing at all!" When I did my assessment, I could not find much - he has a band-aid on his toe, he ripped a toenail off the day before, he noted a cough which he noticed today, non productive. He has urgency when he needs to urinate.
So, here are the few dx I thought of...my signature question, am I on the right track?
1. Decreased cardiac output r/t altered preload and afterload AEB edema, fatigue, c/o dyspnea on exertion.
2. Activity intolerance r/t imbalance between oxygen supply/demand, generalized weakness AEB reports of exertional dyspnea and fatigue, anemia.
3. Risk for situational low self esteem r/t functional impairment, physical illness, and social role change.
