CMP 4/13/14: Na low @ 135, Potassium high @ 5.3, BUN high @ 49, Creatinine high @ 1.8, Albumin low @ 2.2, GFR abnormal @ 29.7
CBC 4/12/14: RBC low @ 3.43, Hemoglobin low @ 9.8, Hematocrit low @ 29.7, PLT low at 110, Neutrophils high @ 69, Lymphocytes low at 20, Monocytes low @ 5, Eosinophils high @ 4
Foley catheter
Red area noted on sacrum
T 97.2 HR 81 R 13 BP 148/81
Appeared confused aeb stated, "My friend is 5 years younger than me. She is 57 and I'm 68 so, let's see, she is 11 years older than I am." Also repeatedly asked who the night nurse that took care of her last time she was at Kindred and was confusing names.
1. Risk for confusion r/t septicemia, polypharmacy, decreased hemoglobin, electrolyte imbalances, increased BUN/creatinine, malnutrition, over 60 years of age
2. Risk for electrolyte imbalance r/t chronic kidney disease.
3. (possibility) Risk for impaired skin integrity.
or
4. (possibility) Risk for infection r/t Foley catheter.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
YOU are overwhelmed...((HUGS))
D10 is for peripheral TPN. Central glucose is usually D50. To reach proper carbohydrate requirements on adults the dextrose concentration is typical 50-70%Dextrose and is in a central line. Hence the insulin coverage for the high glucose content. Knowing the contents of your TPN is just as important as your other meds. It impacts your care of the patient.
THe insulin is for coverage if the glucose gets too high.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I am sure it has to do with her diagnosis of short gut syndrome. This occurs because the rapid "dumping" of food triggers the pancreas to release excessive amounts of insulin into the bloodstream. This type of hypoglycemia is referred to as "alimentary hypoglycemia."
Which also puts her at Risk for unstable blood glucose.
Trust me ... it's a knowledge base thing in my opinion ... at least it was for me. It appears the same for you! You just didn't know about the TPN.... see?
:breathe:
This semester (last semester) has been a review semester for me. I've filled in so many gaps and everything just makes so much more sense now. Dare I say it's sort of awesome!?
feel confident to LEARN now after graduation but I'm also scared and I think that's good too.
May I make a suggestion? When you're trying to sort through your reams and reams of assessments (and BTW: Good on you... you had a bunch of data) why don't you start at the most basic things... and go from there. 1. Did your patient have problems with oxygenation? (Sorta... she's anemic, but not life-threateningly so). (2) Does she have a fluid and electrolyte problem (Well... yes. She's got renal disease. But again, is it life-threatening at this point? With a Creatinine of 1.8... she's kinda OK for now.) The NEXT most important physiological need...(3) NUTRITION. Her chemistries scream that she is nutritionally deficient. She is on TPN. She has an ileostomy (did you tell us why? Whatever, with an ileostomy, she's not absorbing everything she eats. And if there's remaining GI pathology... even more so.) (4) Does she have issues with elimination? Well yes... but she has a foley and an ileostomy, and so this is more or less stable, meaning she is peeing and pooing. (5) What about sleep/comfort/rest/restoration? You mention fentanyl patches... so maybe this is also a problem. (6) Mobility? Probably... she has a pressure sore. In my minds eye it would seem she would be tough to mobilize much. Finally (7) there is physiological homeostasis (things like clotting cascade, autonomic stability, IMMUNITY and so on). Your patient is at high risk for infection (Central line, low WBC's, foley catheter, chronic illness, nutritionally deficient) but she's on Abx and this would seem to be under some control for the moment.
Go through that list. Which area is the highest physiological priority with the most impairment? Yeah... you probably are saying nutrition. Knowing that... dig in deeper and get additional data on that. Like (as suggested) what's in her TPN? Is she on Folate? thiamine? etc. (probably in the tpn)... go with that and write your priority diagnosis.
Then go to the next highest physiological priority and seriousness of impairment or risk. Focus hard on all the data you have in that category. Write a diagnosis.
Also, I had a pt previously with a foley and he was on an antibiotic for his wounds. My instructor said that since his antibiotic therapy was directed for his wounds, he is still at risk for infection r/t foley.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Also, I had a pt previously with a foley and he was on an antibiotic for his wounds. My instructor said that since his antibiotic therapy was directed for his wounds, he is still at risk for infection r/t foley.
any patient with invasive lines is in danger of infection. That is the whole focus of preventing hospital acquired infections.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Esme12, that may a little above me right now! Ha.
It shouldn't be too far above you.
When you are doing a care plan you need to up all of your patients diseases and understand the pathophysiology. You have had A&P...so you need to start to make the connection between the 2. One is normal, what is abnormal, and how the disease affects the patient.
Connecting the dots is how you come to complete understanding.
That is why I am not a huge fan of the NANDA LIST. It focuses the students attention on that LIST of words and definitions....not on the patients over all picture and how/why the disease effects the patient.
I need to utilize your sheets! I'm not sure why I've never thought to put it in body systems so to speak.
There is SO much information learned in school I have a hard time keeping up. With every class our teacher says our standard raises and we need to know everything we learned and apply it. I know we need to, but getting 4 chapters in a week and care plans and assessments; its just hard to know what to pick out of the air so to speak. I'm in information overload, my poor little brain is struggling to process new information and its tough to get back to what I've learned last year!
Esme12, ASN, BSN, RN
20,908 Posts
YOU are overwhelmed...((HUGS))
D10 is for peripheral TPN. Central glucose is usually D50. To reach proper carbohydrate requirements on adults the dextrose concentration is typical 50-70%Dextrose and is in a central line. Hence the insulin coverage for the high glucose content. Knowing the contents of your TPN is just as important as your other meds. It impacts your care of the patient.
THe insulin is for coverage if the glucose gets too high.