paraplegic pt. diagnoses help

  1. 0 I have a pt. that I have to write a careplan on who is a paraplegic and I'm not really sure about what diagnoses to pick. This pt. came in because they had bilateral DVTs and when they were admitted they found out this pt had a UTI. The pt. was using a foley catheter at home and was on a foley in the hospital as well but that was d/c and a straight cath will be used instead.

    The two priority diagnoses that I was thinking of was ineffective peripheral tissue perfusion and impaired urinary elimination but like I said above i'm not really sure if these are the best ones to pick. Are there any better ones? or are these good?

    Any help will be greatly appreciated! Thank you!
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  3. Visit  Deezywheezy} profile page

    About Deezywheezy

    Joined Oct '11; Posts: 4.

    17 Comments so far...

  4. Visit  PsychNurseWannaBe} profile page
    0
    What would be your r/t and AEB?
  5. Visit  Deezywheezy} profile page
    0
    Ineffective Peripheral Tissue Perfusion r/t paraplegia and second hand smoke exposure AEB HCT 31.6L, HGB 10.9 aptt-heparin: 57.1. Absent pedal pulses only heard w/ doppler and were weak b/l. puffy legs w/ +2 edema b/l, cap refill >3 sec b/l. Pt. not unable to move from the waist down.

    situational low self esteem r/t loss of independent functioning AEB poor eye contact, quiet, withdrawn, dull affect, consulted psycho for depression- prescribed cymbalta.

    reflex urinary incontinence r/t neurological impairment above level of sacral AEB no sensation of bladder fullness, inability to voluntarily initiate voiding, used foley catheter at home.

    I'm kind of stuck on what to do... i think ineffective peripheral tissue perfusion is a definite because the chief complaint was bilateral DVTs. But I also wanted to do something with her UTI but i'm not sure what kind of diagnoses to give her...
  6. Visit  GrnTea} profile page
    0
    actually, the dvts are not so much a cause of inadequate tissue perfusion, are they? how would venous clots slow or impair tissue perfusion, which is generally thought of as an arterial problem?
    so for the dvt, think about what that puts him at risk for, both the condition and the meds they'll put him on for it; think about how you would watch for complications, teach him about his new med, and make his environment safe with it.

    now. let's break this down:

    "ineffective peripheral tissue perfusion r/t paraplegia and second hand smoke exposure aeb hct 31.6l, hgb 10.9 aptt-heparin: 57.1. absent pedal pulses only heard w/ doppler and were weak b/l. puffy legs w/ +2 edema b/l, cap refill >3 sec b/l. pt. not unable to move from the waist down."

    is ineffective tissue perfusion caused by paraplegia? caused by 2ndhand smoke? not so much, i don't think-- marginal in the smoke, and temporary. does a low h/h and clotting study tell you how the paraplegia and the 2ndhand smoke cause problems? not really, either. at least not first-line problems.

    now, though, if you rethink this, you're on to something with ineffective tissue perfusion, and i'd advise you to carry it a little further.
    think about this: he has low oxygen-carrying capacity even if he has decent spo2 (low levels of red cells and hemoglobin to carry oxygen, and spo2 is only a percentage of the red cells carrying o2, not an absolute measure of how much oxygen is being carried).

    did you know that paraplegia increases risk of cardiovascular disease?
    he has poor peripheral pulses, and his capillary fill is slow. he's edematous mostly because he has no venous pumping going on since his muscles don't work, unless he has an additional diagnosis of chf, which will make it worse.
    so if a paraplegic has lousy tissue perfusion and no sensation, what does that put him at risk for? how would you assess for it? what nursing measures would you put into place to assess him and prevent those complications? how would you teach him about this, how to prevent it, and what to do if it happens?
  7. Visit  Nurseskeeper} profile page
    0
    I did a careplan that is similar to this

    you should try these: ineffective peripheral tissue perfusion r/t immobility and risk for impaired skin integrity r/t immobility.
  8. Visit  grantz} profile page
    0
    Make it more complex and deadly.. Risk for tissue necrosis r/t altered tissue perfusion s/t CHF
  9. Visit  xtxrn} profile page
    0
    Quote from grantz
    Make it more complex and deadly.. Risk for tissue necrosis r/t altered tissue perfusion s/t CHF
    When did the CHF happen?


    Make it realistic for the actual patient.

    Unless he's about to lose a limb (that hasn't happened either), this isn't appropriate.
  10. Visit  grantz} profile page
    0
    Quote from xtxrn
    When did the CHF happen?


    Make it realistic for the actual patient.

    Unless he's about to lose a limb (that hasn't happened either), this isn't appropriate.
    it is..heart failure is the heart failed to pump sufficient blood that should circulate to the system right? so therefore the tissues are not perfused adequately
  11. Visit  xtxrn} profile page
    0
    Quote from grantz
    it is..heart failure is the heart failed to pump sufficient blood that should circulate to the system right? so therefore the tissues are not perfused adequately
    LOOK AT THE ACTUAL POST being asked about, please. This is someone's actual question about someone without CHF.

    The only thing you're showing is inexperience. Joking around about someone in school looking for help is cruel.
  12. Visit  grantz} profile page
    0
    Quote from xtxrn
    LOOK AT THE ACTUAL POST being asked about, please. This is someone's actual question about someone without CHF.

    The only thing you're showing is inexperience. Joking around about someone in school looking for help is cruel.
    Sorry about that. I'm just assuming that the thombus are dislodge that causes CHF. If my comment won't it's Ok I'll accept it.

    PS Im not joking around ma'am
  13. Visit  xtxrn} profile page
    0
    Quote from grantz
    Sorry about that. I'm just assuming that the thombus are dislodge that causes CHF. If my comment won't it's Ok I'll accept it.

    PS Im not joking around ma'am
    OK....good to know

    A thrombus dislodged is more likely to cause a pulmonary embolism or stroke. CHF isn't at the top of the list. Could be a complication of a PE....but not as likely in and of itself.
    Last edit by xtxrn on Oct 31, '11
  14. Visit  grantz} profile page
    1
    Quote from xtxrn
    OK....good to know

    A thrombus dislodged is more likely to cause a pulmonary embolism or stroke. CHF isn't at the top of the list.
    Thank you for clearing it up I'd rather edit it to make it more realistic but unfortunately I can't so maybe I'll just leave it their.
    xtxrn likes this.
  15. Visit  GrnTea} profile page
    0
    a dvt will not cause a stroke, although many people who have forgotten normal circulation anatomy think it will. follow the blood flow from leg to brain-- how would a clot get to the brain from there? is there another risk from dvt that would be more likely?
    (an arterial thrombus, e.g., in a carotid artery or an intracardiac thrombus in the left heart, could cause a stroke, though.)

    in terms of necrosis in peripheral tissues, is anybody here remembering that this is a paraplegic? hint, hint, hint.

    if i don't see the actual answer by the end of tomorrow i will just have to tell you, i guess, but risk of this complication is so basic to paraplegia care that i'm astonished nobody has it by now. while accelerated cardiovascular disease will make it more likely, it's a huge risk in any para, young or old, recent or remote.


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