Requesting input please

  1. Hi there. I am new to the boards. Already posted in Introduction and greetings!!~
    I am working on a case study for class. I have this patient with the following:
    70 y/o female c/o severe abd pain, N/V, she thinks there may be white spots all over in her mouth. She feels miserable, lives alone, lost about 20 lbs over past 3 months, pain in legs, tired, unable to do much, weak, tired all the time. Pt states history: HTN, "maybe" kidney problems. She urinates sometimes (pain when she does), admits to malodorous urine.
    I must list numerous nursing diagnosis, vitamins she is deficient in, nursing interventions, diagnostic procedures to be done, anticipated Dr orders (diet, meds, labs, activites), Meds I would anticipate her being on, etc....
    In addition I have to create a concept map and care plan.
    I was just wondering what all of you think she has? I am working on this now and thought who better to ask than all of you.....please let me know what you think......
    this one will keep me busy for a while....
    Thanks a million for any input.

    Reese4Dolphins
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  2. 9 Comments

  3. by   NJNursing
    With the pain and malodorous urination, I'd suspect UTI there and if she's on a broad spectrum antibiotic, that can cause thrush thus the white spots in her mouth. It's basically an oral yeast infection. If the UTI was left untreated for a long time, she could have a bladder infection thus the abdominal pain. However all of that could be secondary to something bigger like cancer. That's just my guess.
  4. by   DusktilDawn
    Quote from NJNursing
    With the pain and malodorous urination, I'd suspect UTI there and if she's on a broad spectrum antibiotic, that can cause thrush thus the white spots in her mouth. It's basically an oral yeast infection. If the UTI was left untreated for a long time, she could have a bladder infection thus the abdominal pain. However all of that could be secondary to something bigger like cancer. That's just my guess.
    In addition to this, what about depression (lives alone, wt loss, feels miserable, unable to do much, weak, tired all the time) and in regards to the pain in the legs look into PAD (peripheral arterial disease) or PVD (peripheral vascular disease). PAD can produce symptoms in cardiac, cerebral, and renal vascular systems.
  5. by   NJNursing
    And the pain in the legs could also be a DVT from being sedentary and often laying/sitting around for long periods of time. And I also agree about the PAD/PVD.
  6. by   Daytonite
    "She urinates sometimes. . ." indicates either a dehydration or perhaps a kidney problem of some kind as that is not normal. A malodorous urine could be a UTI or could be dehydration. HTN, the nausea and vomiting and the feeling miserable also go along with possible kidney failure. The weakness and tiredness point to possible dehydration and malnutrition. The weight loss points to malnutrition.

    A chem panel/CBC/and urinalysis with C&S should be ordered for sure. You are probably going to need to start an IV access. The doctor is likely to order GI, GU, and kidney consults. GI will most likely want to scope her because of the nausea, GU will probably want an ultrasound of the bladder and kidney is going to want to start will an ultrasound of the kidney and look at labwork like BUN and creatinine. Without knowing anything else about her condition you would need to do a nursing assessment, get her weight and inquire about diet and current activity. I'd check that mouth of hers as well.
  7. by   DusktilDawn
    Quote from NJNursing
    And the pain in the legs could also be a DVT from being sedentary and often laying/sitting around for long periods of time. And I also agree about the PAD/PVD.
    Another possibility.
    But we need to examine the 5th vital sign. In regards to c/o "abd pain" and "leg pain" a more in depth analysis of the pain is required. Are there precipitating factors, does the abdominal pain or leg occur after certain activities such as walking or moving a certain way or do certain activities make it worse or better. The quality of the pain, such as aching, stabbing, cramping, burning, tearing, pulling, etc. The intensity such as 1/10 or 10/10. Is it intermittent or intractable. Onset and duration. Does it radiate. Location, for instance epigastric area, RUQ, calf pain. What provides relief, for instance does elevating the legs increase or decrease the pain. Pattern of the pain, does leg pain occur after a certain amount of activity or when the abdominal pain occurs in relation to eating. Concomitant symptoms such as, for instance, pain from an inflammed gallbladder or kidney stone will frequently cause nausea or vomiting. Also is the abdominal pain or leg pain a new development or have they been dealing with this over a lengthy time span. Reaction to pain, some people exhibit very little non-verbal cues, while others are not only quite verbal, they will have facial grimaces, may be doubled over and rocking, basically people express pain differently based on numerous factors. What measures does the pt usually take in regards to pain relief. What is the patient's experience in regards to pain and beliefs about pain. How is the pain affecting or influcing the patient on a daily basis in regards to normal activity.

    There are so many factors to consider when assessing pain. I'm sure I didn't mention them all. Also as a nurse are there prejudices and misconceptions in regards to pain that we may have that can affect how we treat/manage pain with our patients.
    Last edit by DusktilDawn on Nov 25, '05
  8. by   Reese4Dolphins
    These are all wonderful responses! Thank you so much. I am researching each and every reply and trying to put it all together.

    The scenario doesn't go into much detail other than what was in my original post. It doesn't say if she was on Antibiotics (regarding the thrush), or what contributes to the insensitiy of pain in her legs, her history said "maybe" she thinks she might have something wrong with her kidneys.
    Did I mention she stated that she was in perfect health up until a few weeks ago.... I think that makes a difference as well.

    TI love these scenarios, but I keep reading into it like what if, and I dont think I am supposed to do that.............

    Thanks again in advance!!~
  9. by   Britcan
    Quote from Reese4Dolphins
    These are all wonderful responses! Thank you so much. I am researching each and every reply and trying to put it all together.

    The scenario doesn't go into much detail other than what was in my original post. It doesn't say if she was on Antibiotics (regarding the thrush), or what contributes to the insensitiy of pain in her legs, her history said "maybe" she thinks she might have something wrong with her kidneys.
    Did I mention she stated that she was in perfect health up until a few weeks ago.... I think that makes a difference as well.

    TI love these scenarios, but I keep reading into it like what if, and I dont think I am supposed to do that.............

    Thanks again in advance!!~
    Could some one please help me with some information pertaining to the Gibbs Handwashing Techniques or where I could find this on the internet . Thanks Britcan
  10. by   DusktilDawn
    Reese, is it the purpose of your case study to determine what diagnosis this person may have or to figure out what areas of assessment you want to look into as a nurse?
    lost about 20 lbs over past 3 months
    Did I mention she stated that she was in perfect health up until a few weeks ago.... I think that makes a difference as well.
    If she was in perfect health a few weeks ago, why the weight loss?
    Was the weight loss intentional?
    If this was an actual patient I would ask:
    For a clearer defination on the weeks, 4 weeks, 8 weeks, etc. Is three months a few weeks to this patient.
    she thinks she might have something wrong with her kidneys.
    Was this told to her by a health care provider and if so did she follow-up? Daytonite mentioned kidney failure and this may be the right tract in this scenario.

    Vague statements made by patients need to be clarified when providing assessment.
  11. by   Reese4Dolphins
    Hi. Thanks again for the quick replies.
    I will just type out the scenario questions that I am to answer.
    List 6 possible nursing diagnosis and prioritize
    List the vitamins deficient in her diet and discuss how they relate to her presenting symptoms
    List & explain 8 expected nursing interventions (prioritize)
    List & explain diagnostic procedures you would anticipate for this pt
    List medical orders you would anticipate (meds, labs, diet etc)
    List & explain resources of importance you would recommend
    List at least 8 meds you would anticipate being ordered (indications & side effects, too) {I am in the middle of looking these up in the med book}
    List & explain important education needs or topics.

    In addition create a plan of care in the form of a table include:
    nursing diagnosis, measurable goals, nursing interventions, rationales for interventions & expected goals/outcomes.

    ps this is not a real patient but here is what I have exactly:
    "Mrs S a 70 yr old female presented to the hospital w/ c/o severe abd pain/n/v & she thinks there may be white spots all over her mouth. She states " I feel miserable". Mrs S lives by herself and has no relatives living in close proximity to her at this time. She reports that she might have lost about 20 pounds over the past 3 months and has pain in her legs that bothers her daily. She states that she is usually very tired and is unable to do a lot for herself. Mrs S reports that she was in perfect health up until a few weeks ago when she started feeling weak and tired all the time. She states that she has a history of hypertension and maybe something wrong with her kidneys. She is not sure what the Dr's have told her before. She urinates sometimes and there is pain when she does. She also reports a very foul odor to her urine.


    Thanks you once again so much for your input!!!

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