can you look at my ND's and goals please

[direw0lf, BSN]

I don't like writing these.....can anyone please let me know if these are good or need work and which need work ?

These are for DKA.

ND's:

Fluid Volume Deficit R/T osmotic diuresis due to hyperglycemia A/E/B dry mucus membranes and skin.

Electrolyte Imbalance R/T DKA A/E/B glucose 574, potassium 5.4, calcium 7.2, and phosphorus 2.0.

Risk for Infection (sepsis) R/T increased levels of glucose, leukocyte dysfunction, and changes in circulation.

Short term goals:

Fluid volume deficit – Patient will achieve fluid balance as indicated by moist mucus membranes, normal ranges for vital signs, and elastic skin turgor by the end of the shift.

Electrolyte imbalance – Patient's glucose will be 80-150 within 24 hours and potassium level will be 3.5-5.0 within 12 hours after intervention.

Risk for infection (sepsis) – Patient will maintain a normal temperature to the end of the shift.

Long term goals:

Fluid volume deficit – Patient will be able to clearly state symptoms and causes of osmotic diuresis and measures that can be taken to treat or prevent fluid volume loss following current hospitalization.

Electrolyte imbalance – Patient's occurrences of nausea and vomiting will be completely eliminated in one day.

Risk for infection (sepsis) – Patient will perform good foot hygiene to prevent ulcers.

Interventions:

1. Fluid volume deficit – Maintain patent IV access for fluid replacement therapy. Isotonic IV fluid such as 0.9% normal saline allow replacement of intravascular volume.

2. Electrolyte imbalance – Assess for signs of worsening hyperkalemia: decreased blood pressure, dysrhythmias (ventricular fibrillation), peaked T waves, prolonged PR interval, wide QRS complex, bradycardia, GI cramping. Assess for signs of hypokalemia: fatigue, malaise, confusion, muscular weakness, cramping/pain, shallow respirations, and abnormalities in cardiac conduction with potential for a variety of arrhythmias. Report levels

3. Risk for infection - Educate patient concerning peripheral neuropathy and the importance of foot care and hygiene.

Evaluation of Interventions:

Fluid Volume Deficit – Patient states that polyuria can increase fluid volume deficit risk, and that polydipsia, dry skin, hot skin, restlessness are signs of hypovolemia and that he should contact his health care provider or seek medical treatment if this occurs. Patient will also state that hyperglycemia can be a precursor to fluid volume deficit/hypovolemia.

Electrolyte Imbalance – Patient was able to reduce vomiting and maintain normal blood glucose levels.

Thank you in advance Id really appreciate feedback thanks!

[Triddin]

So you're missing a lot under interventions for electrolyte imbalances. Yes, we monitor for electrolyte balances, but what are we doing to prevent them? Are you only running an access for fluid volume? What type of fluid is this? Are you replacing electrolytes? How fast do you want your sugars to correct? What are you doing to prevent hypoglycaemia?

What was the precipitating factor causing the patient to develop dka? Where they sick? All out binge at the jelly bean factory? You would want to address these causes too.

[direw0lf, BSN]

So you're missing a lot under interventions for electrolyte imbalances. Yes, we monitor for electrolyte balances, but what are we doing to prevent them? Are you only running an access for fluid volume? What type of fluid is this? Are you replacing electrolytes? How fast do you want your sugars to correct? What are you doing to prevent hypoglycaemia?

What was the precipitating factor causing the patient to develop dka? Where they sick? All out binge at the jelly bean factory? You would want to address these causes too.

Thanks! My case study is really so far 14 pages long, and I have the insulin admin and IV fluids under current meds and tx section but I will also include it for interventions! Even the nurse told me use knowledge deficit but we need 2 actual and 1 potential ND's...and to me fluid and electrolytes are the more urgent right? I might switch though. Or switch risk for infection to risk for knowledge deficit.

The patient states he didn't know how to change the battery on his glucometer so he wasn't able to check his sugar. Denied any illness and denied not complying to insulin regimen.

Thank you again :)

Oh also that was the weird part, he was only prescribed insulin and NS, nothing to lower the K+ I think in my reading because it will shift on its own to possibly hypokalemia

[WanderingWilder, ASN]

Oh also that was the weird part, he was only prescribed insulin and NS, nothing to lower the K+ I think in my reading because it will shift on its own to possibly hypokalemia

The insulin will push some of the K+ back into the cells where it came from. Its also looks high because the blood is more concentrated once you replace the volume the K+ will be lower not because there is less k+ in the blood but because the blood will be less concentrated.