I have to list 3 priority nursing diagnoses for a case study 21 year old male, brought to urgent care by friend, sore throat past week. Always thirsty, has tried to drink fluids and sleep but wakes q 2-3 hrs to urinate. VS: BP 90/62, P 102, R 30 deep and labored, and enlarged lymph nodes in neck, lungs CTA, heart tones regualr, no murmur or rub. Abdomen is tense and slightly tender. Skin dry, turgor poor,decreased deep tendon reflexes. He admits to feeling tired past month, thinks he has lost weight even though he has been eating "a lot". He's requesting antiobiotics to make him feel better.
: hgb16g/dl Hct 53% RBC 5.0
WBC 15,200/mm neutrophils 63% lymphs 27%
Na 146 Cl 100 K 2.5 HCO3 2meq
Glucose 782 Bun 48 Creat
Urine specific gravity 1.035
Ketones large and throat culture strep positive.
I know increased Na caused by fluid deficit, Bun high from dehydration because creat ok. WBC is because of the strep.
I've come up so far with
Deficient fluid volume
r/t excessive urinary output AEB thirst, freq urination q 2-3 hrs, temp 102, sore throat, BP 90/62. HR 30, lethargic, dry skin, deep tendon reflexes, pt complaint "feeling tired past month".
I'm pretty sure he has non managed diabetes from labs high glucose, concentrated urine, pot is low because of hyperglycemia so my next diagnosis would be:
Ineffective Health Maintenance
r/t insufficient knowledge of effects of diabetes not being managed AEB request of antibiotics to make him better.
I was going to use ineffective breathing pattern r/t fatigue AEB R30 deep and labored breathing. I know I can't use r/t DK, or hypglycemia, but the fatigue is because of the fluid loss, so this diagnosis i don't think i can use because fatigue will be fixed once he receives fluids.
Maybe acute pain from ketones,(abdomen is tense)? but it doesn't state in the case study he's in pain.
I need help please, I've spent way too long on this 4 days and I have another due on monday as well, and 2 final exams in 2 weeks. I think i'm making this too difficult.
any help would be appreciated.