POC Anemia secondary to chronic blood loss

[mlauren]

Hello again, I'm doing my POC for this week and having some trouble finding a ND. To start, this patient is a 47 year old female admitted for a total abd hysterectomy, with chronic blood loss due to uterine fibroids. Her symptoms are pelvic pain, urinary frequency, constipation, and painful intercourse. She has been taking Lupron Depot for 6 months with no success. She is also anemic and taking ferrous sulfate. Other symptoms due to this are weakness, fatigue, and pallor. She has a history of upper respiratory tract infections, but no other medical problems. Vitals signs are BP 132/82, T 98.5, pulse 74, resp 14. O2 sat 99%/ Heart sounds audible S1 and S2, peripheral pulses 3+ bilaterally (radial, and pedal), bowel sounds audible in all 4 quadrants, abdomen distended and firm, foley catheter draining clear yellow urine, IV of D5 1/2 NS running at 100 ml/hr.

Since she is anemic I want to include that in my top 3 ND, but I'm having a hard time figuring out where to go with that. Should I be using Imbalanced nutrition less than body requirements? Is there any other diagnoses I can use for this? I am looking in my ND book, but not having much luck.

I know pain will be a ND, because she is already in pain and will more than likely be in pain after surgery. I have a lot of "risk for" diagnoses listed on my POC already, such as risk for constipation, risk for infection, risk for ineffective airway clearance, and also fatigue and activity intolerance.

I will be buying a Care plan bk. next week and hopefully that will reduce the amount of stupid questions I post on here. But until then thanks to all of you who are willing to help.

[BostonFNP, APRN]

Try basing your ND off of your assessments instead of the medical dx.

What does your assessment of this patient lead to?

[mlauren]

Ok, anemia can lead to a rapid or irregular heart rate and heart failure (I just have to look for the ND related to that), and what about impaired gas exchange rt altered oxygen-carrying capacity of blood?

[MendedHeart]

Impaired/altered tissue perfusion-peripheral

[MendedHeart]

Decreaded Cardiac output

[MendedHeart]

I think you can only use impaired gas exchange if the pt is on oxygen...if on RA...they arent impaired yet

[MendedHeart]

And remember. .the patients "risk for" NDs with the exception of aspiration and bleeding..are always last compared to actual problems. .your pt vital signs are fine right now..her pale skin and bounding pulses can be used for data to support the impaired tissue perfision and probably decreased cardiac output

[mlauren]

Ok, but on the scale we go by 3+ is normal. Another question, if I'm not able to support these diagnoses to use them without the risk for, should they still come before other actual diagnoses that are not related to ABCs?

[MendedHeart]

I think the pulse you can leave out but pallor and fatigue are definitely signs of anemia...altered tissue perfusion you can use for that..what were her labs..were her lytes off? Fluid balance? Actual problems trump risks for regardless of ABCs 95% of the time..are you allowed to use PC's?

[MendedHeart]

Definitely use something related to her surgery such as impaired tissue integrity or something like that r/t surgical incision

[mlauren]

OK, I did not realize I had left labs out...Hgb 10.2, Hct 30.6, and RBC 3.4, WBC 8.7. Thanks for clarifying that for me. And I don't know what you're referring to > PC?

[MendedHeart]

Ok so H&H a lityle bit low..but not really horrible. .usually wouldnt transfuse until less than 7-8 ..but its just low enough to probably have her feeling fatigued and weak..so yes my #1 would probably be Altered tissue perfusion : peripherals r/t a decreased amount of oxygen carrying capacity in blood 2° anemia, #2 id go Impaired tissue/skin integrity maybe or Acute pain. Were electrolyte s ok? A PC is a Collaborative Problem or Potential Complication. This is where a nurse can use a medical diagnosis in place of a ND if it highest priority..example. >> P.C.:Hemorrhage r/t puncture wound to abdomen 2° stabbing---- just an example not relayed to ur case.