Brain cancer metast. from lung, Diagnosis??

[nursetobehopefully]

Thank you everyone for your help, your advise defintly got me in the right direction and I got a 90!!

However I have my last care plan due before my finals and my patient was in for altered mental status and was found that his lung cancer had metastasized to the brain, a mass was found in the left frontal lobe. I could choose not do do the care plan on this particular patient and do it on a patient with degenerative discs, but I really am interested in this one. The patient had altered mental status, oriented to person and place at times, had aphasia, right side facial droop, and starting to show signs of right sided foot drop. Abnormal labs- protime high, glucose 182 (tpn), INR high, WBC high, RBC low, H&H low, MCV low, MCHC low, B&C ratio high, Nuets high, lymphs low. Hx of smoking (quit recently), HTN, Hep C, pancreatitis. Pt is a DNR and will be going home with Hospice and a supportive family. Pt is at risk for ICP, and Falls(but I can't use Fall Risk). I started with Innefective cerbral tissue perfusion and thinking about nutrition, less than body requirements. Any ideas would be appreciated!!

[cb_rn]

how much do you know about palliative care?

I found doing hospice people had a wide range of expectations for what hospice was and wasn't. And it wasn't what I thought it was, either! A knowledge deficit careplan about hospice would be interesting for you to produce if you don't have a really clear concept of what hospice is about

[nursetobehopefully]

The pt is going to hospice, I treated the pt. on an acute basis, so therefore I need to have diagnosis that fit the time spent on the Med-Surg floor, not hospice. So that is why we were not treating palliative, the pt is still recieving radiation, decadron, etc. So I need diagnosis to fit the acute stage of illness not palliative, but thank you!

[LouisVRN, RN]

Obviously first and foremost, tissue perfusion (altered cerebral). Gas exchange, impaired, Risk for injury, family process, altered, grieving, anticipatory all come to mind.

[Xavier01]

Have you thought about a psychosocial diagnosis pertaining to his altered mental status, new palliative care, and newly implemented DNR? You could even write a diagnosis about altered family processes or something about risk for impaired grieving (terminology is off, I'm not looking at a book) because of aphasia, altered mental status. Hope that gives you a few ideas! Good luck.

[nursetobehopefully]

Thank you! My first is Innefective Tissue Perfusion, and then I was going to use Nutrition, less than. I was thinking between altered mental status and a pychosocial but my instructor is not to thrilled when we put those on there! So the three I'm going to use are ineffective tissue perfusion, cerebral, altered thought process and nutrition, less than body requirements. Sound Good?? Hope so, last one before finals!!

Then its time to do a few more clinicals and boards time, can't wait:nurse: