Am I on the right track?

[takingcare19]

So here are my ques and a couple dx so far....

Age - 68

Admitting dx: septicemia

On continuous TPN, although the day I treated her, her doctor allowed regular diet. I believe eating or not, she is always on TPN.

CV line left upper arm

Ileostomy RLQ

Hx of severe protein calorie malnutrition

Hx of chronic kidney disease

Hx of hyperlipidemia

CMP4/14/14: BUN high @ 53, Creatinine high @ 2, Albumin low @ 2.3, Bilirubin high @ 1.3, AST high at 41, GFR abnormal at 26.3

CBC 4/14/14: WBC low @ 3.7, RBC low @ 3.2, Hemoglobin low @ 9.4, Hematocrit low @ 28.1, PLT low @ 128, Eosinophils high @ 9

Vitamin b-12 4/13/14: >1000 high

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.

Medications: Fentanyl patch, fluticasone propionate, meropenem, vancomycin, piperacillin, zolpidem tartrate, morphine, Ipratropium, hydrocodone/acetaminophen, diphenhydramine

DX:

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.

Any guidance is appreciated!

[Esme12, ASN, BSN, RN]

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!

((HUGS)) You are going to spend a TON of time in the beginning of your career looking stuff up. I would come home and look up everything I saw that day the rest of my career. Your list to look up will get shorter and shorter every year....but you will be learning the rest of your career in nursing.