Nursing diagnosis: osteomyelitis and a-fib

  1. 0
    HELP PLEASE!
    I'm doing a care plan on a patient with atrial fibrillation and osteomyelitis. I have to put these dx's in order of priority. Assessment is as follows... B/P: 122/70, temp: 98.8. Neuro: Neuropathy in fingers. cardiovascular: Weak peripheral pulses, cool pale extremities, PICC line. Pain: occasional reports of pain at PICC line and finger. No genitourinary, psychosocial, GI probs. Musculoskeletal: osteomyelitis. Integumentary: PICC line in place.
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  3. 4 Comments so far...

  4. 1
    Where are your nursing diagnoses?
    TIREDSTUDENTRN likes this.
  5. 0
    I'm toying with:
    Decreased cardiac output r/t alteration in preload, Ineffective peripheral tissue perfusion r/t mechanical reduction of venous and / or arterial blood flow, Impaired tissue integrity r/t, Risk for infection. What do you think? I wanted to do a PC: infective emboli or DVT, but I cannot remember how to put it on the care plan (how to write it up/ if I need a r/t or aeb, etc.) I'm going crazy here! Any tips would be greatly appreciated!
  6. 2
    use the nursing process to help develop you care plan in the the sequence that the steps occur.
    1. assessment (collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
      • a physical assessment of the patient
      • assessment of the patient's ability and any assistance they need to accomplish their adls (activities of daily living) with the disease
      • data collected from the medical record (information in the doctor's history and physical, information in the doctor's progress notes, test result information, notes by ancillary healthcare providers such as physical therapists and dietitians
      • knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. this includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. if this information is not known, then you need to research and find it.
    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). it helps to have a book with nursing diagnosis reference information in it. there are a number of ways to acquire this information.
      • your instructors might have given it to you.
      • you can purchase it directly from nanda. nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international. cost is $24.95 http://www.nanda.org/html/nursing_diagnosis.html
      • many authors of care plan and nursing diagnosis books include the nanda nursing diagnosis information. this information will usually be found immediately below the title of a nursing diagnosis.
      • the nanda taxonomy and a medical disease cross reference is in the appendix of both taber's cyclopedic medical dictionary and mosby's medical, nursing, & allied health dictionary
      • there are also two websites that have information for about 75 of the most commonly used nursing diagnoses that you can access for free:
    3. planning (write measurable goals/outcomes and nursing interventions)
      • goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing. they have the following overall effect on the problem:
        • improve the problem or remedy/cure it
        • stabilize it
        • support its deterioration
      • interventions are of four types
        • assess/monitor/evaluate/observe (to evaluate the patient's condition)
          • note: be clear that this is assessment as an intervention and not assessment done as part of the initial data collection during step 1.
        • care/perform/provide/assist (performing actual patient care)
        • teach/educate/instruct/supervise (educating patient or caregiver)
        • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
    4. implementation (initiate the care plan)
    5. evaluation (determine if goals/outcomes have been met)
    i cannot tell how you arrived at your choice of nursing diagnoses. every nursing diagnosis has a set of defining characteristics. i cannot tell how you utilized your patient's symptoms in arriving at the 4 diagnoses that you came up with since i only picked up on 3 symptoms that you posted. this is how i used the nursing process and the information you supplied to come up with nursing diagnoses for this patient:

    step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology
    • atrial fibrillation
    • osteomyelitis
    • neuropathy in fingers
      • treatment:
        • picc line - why is there a picc line? what ivs and iv meds does this patient need to be on that require the presence of a picc line?
        • what other drugs is the patient receiving?
    step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data
    • weak peripheral pulses
    • cool pale extremities
    • occasional reports of pain at picc line and finger
    step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use
    • ineffective tissue perfusion, peripheral r/t unknown pathological condition aeb weak peripheral pulses and cool pale extremities
    • acute pain r/t inflammatory response aeb pain at picc line insertion site
    your diagnostic suggestions are:
    decreased cardiac output r/t alteration in preload
    an alteration in preload occurs when there is congestive heart failure. there are no signs and symptoms of heart failure here. atrial fibrillation is the result of an electrical disturbance, you have no signs or symptoms of the atrial fibrillation to support using it. however, the correct diagnostic statement, if you did have the evidence to support it, would be decreased cardiac output r/t altered heart rate aeb dizziness, palpitations and dyspnea.
    ineffective peripheral tissue perfusion r/t mechanical reduction of venous and / or arterial blood flow
    a "mechanical" obstruction of the peripheral blood flow implies that something is allowed to be done by human beings to obstruct the blood supply to the person's limbs. what is being done by us to do that? this just doesn't sound right to me.
    impaired tissue integrity r/t
    impaired tissue integrity means there is open skin at least as deep as the subcutaneous layer and it could be deeper. this diagnosis is used for surgical incisions, stage iii and iv decubitus ulcers and skin abscesses and boils. there was no mention in the information that you posted that the patient had any of these problems. does the osteomyelitis involve an external wound that goes deep into the bone? was it originally a traumatic injury? you need to describe it, so it can be properly diagnosed.
    risk for infection
    the patient already has an infection--osteomyelitis. he could develop sepsis from the picc line is about the only thing i could see happening, but he is on antibiotics for the osteomyelitis, isn't he? i wouldn't use this diagnosis.
    pc: infective emboli or dvt
    i can see a dvt as a potential problem if the patient is on bedrest (immobile). infection from it is probably not an issue because of being on antibiotics, but ischemia and tissue death from a blood clot lodged in a vein or artery leading to tissue infarction is, so risk for injury r/t altered clotting factors would be the diagnosis to use. there are no aebs because the problem does not yet exist so there can be no supporting evidence. interventions are discussed on http://allnurses.com/forums/2751313-post8.html which has directions on how to write the interventions for these diagnoses.
    Lidunka25 and TIREDSTUDENTRN like this.
  7. 1
    Always start with your abcs. A-fib, maybe decreased cardiac output r/t altered electrical conduction? A pain dx is always an important one for me. Without a more detailed assessment, any more dx I could come up with would just be a guess.
    Good luck!
    TIREDSTUDENTRN likes this.


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