Hi, I'm trying to work on my concept map & I'm just not sure if I'm doing it correctly or not...Our program gave us like a 5 minute lecture on these maps & everyone seems to be lost on it....Anyways here goes....
My diagnosis was: Hyponatremia
Reason for needing healthcare: Falls
Here's some key problems NANDA Diagnoses & supporting data I have so far:
- Altered thought processes r/t neurological dysfunction
1.) Progressive dementia
2.) 65+
3.) Progressive dementia
4.) Reminding patient to watch fluid intake
5.) CT Head results
- Risk for falls r/t diminished mental status
1.) 65+
2.) Patient requires use of assistive devices
3.) History of falls
4.) CT head results
5.) PT results; staggering right leg possibly r/t CT results.
- Excess fluid volume r/t excessive intake of hypotonic fluids
1.) Patients poor appetite but drinks a lot of fluids.
2.) I wanna say intake > output; however, my patient's output was higher than their intake but they did have a high PVR earlier in the day like of 300 mL.
I'm connecting a lot of these boxes together with one another & just see 3 more key problems. But just curious, does that look like I'm doing this right?
So you now say her Na levels are rising...we they low? Are they still low?
What was your actual assessment. Her vitals and labs. What did you see? What did she say? What was her admitting diagnosis? What meds is she on?
Ya, sorry I should've mentioned that. On admission, Na levels were like 124 on 3/4/14 but when we did clinicals last Friday on 3/7/14 they were at 131, so they are improving but they are still a little low. Hematocrit was also pretty low, at about 33.4% which the reason why I thought it was low was because of increased intravascular volume due to dilution.
Also, her hgb was low at about 11.3 which I thought may be due to her poor diet which causes a lack of folic acid & vitamin B12.
Probably should have mentioned lab values too, duh.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Ok so you have hyponatremia....Hyponatremia is defined as a serum sodium level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L. Many medical illnesses, such as congestive heart failure, liver failure, renal failure, or pneumonia, may be associated with hyponatremia. "Mild" hyponatremia is defined as a serum sodium concentration between 130 and 135 mmol/L, "moderate" hyponatremia as a concentration between 125 and 129 mmol/L, and "profound" hyponatremia as a concentration less than 125 mmol/L. Symptoms range from nausea and malaise, with mild reduction in the serum sodium, to lethargy, decreased level of consciousness, headache, and (if severe) seizures and coma. Overt neurologic symptoms most often are due to very low serum sodium levels (usually
Or basically the amount of urine left in the bladder after urination. When we did the bladder scan at about 10 AM she put out about 175 mL but had 300 mL left over. Then at 1240 PM she had an output of 535 mL with a PVR of about 100mL left over.
I've already got my pathophysiology paper done on it too.
When researching on it, I assumed my patient had euvolemic hyponatremia which is related to SIADH & can be caused by dilutional hyponatremia, if that makes sense.
To say that she has SIADH it needs to be proven and documented. Now why is she drinking so much? Is her glucose elevated? Is this a presentation of dementia?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
PVR = Post Void Residual.
Or basically the amount of urine left in the bladder after urination. When we did the bladder scan at about 10 AM she put out about 175 mL but had 300 mL left over. Then at 1240 PM she had an output of 535 mL with a PVR of about 100mL left over.
By this point in time she had an input of 575 mL.
OK...to an ICU nurse PVR is pulmonary vascular resistance. Something altogether different....LOL
OK now you have another problem...Urinary Retention
NANDA describes Urinary Retention as Incomplete emptying of the bladder
[h=4]Defining Characteristics[/h] Absence of urine output; bladder distention; dribbling, dysuria; frequent voiding; overflow incontinence; residual urine; sensation of bladder fullness; small voiding
[h=4]Related Factors (r/t)[/h] Blockage, high urethral pressure, inhibition of reflex arc, strong sphincter
Thanks for all the help, this is really helping me out.
And her glucose was elevated, which I didn't really think of that. And no she isn't diabetic. So I wasn't sure why the glucose was elevated, I assumed labs were drawn after a meal.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I've already got my pathophysiology paper done on it too.
When researching on it, I assumed my patient had euvolemic hyponatremia which is related to SIADH & can be caused by dilutional hyponatremia, if that makes sense.
SIADH is a medical condition The syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH) is defined by the hyponatremia and hypo-osmolality resulting from inappropriate, continued secretion or action of the hormone despite normal or increased plasma volume, which results in impaired water excretion.
She may have low Na due to euvolemic hyponatremia...but this can also be caused by excessive water intake....or water intoxication. Water intoxication, also known as water poisoning or dilutional hyponatremia, is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside safe limits by over-hydration.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thanks for all the help, this is really helping me out.
And her glucose was elevated, which I didn't really think of that. And no she isn't diabetic. So I wasn't sure why the glucose was elevated, I assumed labs were drawn after a meal.
In nursing never ASSume.
What are the symptoms of hyperglycemia? Even learned MD"s cam miss the simplest of things. If she has gone a long time without diagnosis this might explain why she doesn't empty her bladder.
The three biggies...
Polyphagia - frequent hunger, especially pronounced hunger
Polydipsia - frequent thirst, especially excessive thirst
K I do, & will do! Thank you a bunch, this is helping out a ton. As for my etiologic factors, they'll always be my related to something. So, like if I pick Impaired physical mobility it be: Impaired physical mobility related to neurological impairment.
For supporting evidence do you think I could put something such as....Possibly not r/t low sodium serum because as levels increase symptoms don't improve?
Little_Bear2013
105 Posts
Ya, sorry I should've mentioned that. On admission, Na levels were like 124 on 3/4/14 but when we did clinicals last Friday on 3/7/14 they were at 131, so they are improving but they are still a little low. Hematocrit was also pretty low, at about 33.4% which the reason why I thought it was low was because of increased intravascular volume due to dilution.
Also, her hgb was low at about 11.3 which I thought may be due to her poor diet which causes a lack of folic acid & vitamin B12.
Probably should have mentioned lab values too, duh.