cardiac arrerst caused by systemic infection Complicated care plan HELP!!

[anangelsmommy, ADN, BSN, RN]

I am doing a care plan that is a little different than regular care plans. I need to work on nursing dx and interventions I would actually do myself. The problem is that this patient I had was so complicated I dont know where to start, and her dx on admittance is what I am supposed to start with but it isnt neccessarily her real issue. She presented with a cardiac arrest, was revived. She has metastatic cancer and had been on chemo and steroids, she had an infection which had gone undetected and apparently caused the cardiac arrest. Cardiac arrest then also caused renal failure.

So I am thinking possibly decreased cardiac output? but I dont know if having a cardiac arrest is an MI?? I dont know if she had any ECG changes. I didnt get to see strips. She is on beta blocker though. lot of swelling, lasix ordered etc...? any thoughts?

next I was thinking skin integrity because she started getting blisters from the edema and she started getting some sloughing on one side of her ankle. I did have her move every 2 hrs and put pillows under each side when she moved to try to turn her because up to that point she had been on her back for about a week. I put a gauze dressing on her ankle but she had other blisters forming and was afraid they would be starting to slough soon too...any thoughts on what interventions I could do here or other nursing dx might be appropriate?

then my last thought on this was renal failure. Her labs were way off, BUN 77, creatine was really high but starting to come down, she had blood in her urine. Now I would think this would be from the cardiac arrest? but also this can affect cardiac output...kind of like what comes first. I am not sure whether to even include this. I would love some feedback on this, then one of the nurses on the floor said that it wasnt blood in the urine that it was casts because it wasnt sticking together? and she did have good output, it was actually quite high, so perhaps this isnt even appropriate?

another thought I had was risk for infection, due to being on the steroids, having the skin breakdown, having diabetes, and a catheter but can you be at risk for infection if you are already being treated for an infection? it could be another infection? I started to do this one but she is already on antibiotics for a systemic infection, although, sometimes being on antibiotics can leave you at risk for candidia infection, and if you are on steroids you have a weakened immune system...?

like I said this was a bit complicated so I was hoping some experienced nurses would lend me a hand!!

thank you!!

angels mommy

[LVN-RNhopeful]

If you're looking for an all-encompassing diagnosis what about something like Ineffective Protection. Its defining characteristics include: altered clotting, anorexia, cough, deficient immunity , disorientation, dyspnea, fatigue, immobility, impaired healing, neurosensory alteration, pressure ulcers, weakness; and its r/t include: abnormal blood profiles, cancer, drug therapies, inadequate nutrition, treatments (e.g. surgeries, radiation).

[anangelsmommy, ADN, BSN, RN]

well I see that on my nanda list but I dont see it in my book...I am going to have to do some research on this one..I will get back to you. Thank you for the suggestion!

angels mommy

[ghillbert, MSN, NP]

Why on earth was someone with metastatic ca resuscitated, is all I can think!

[anangelsmommy, ADN, BSN, RN]

the family is not ready to let her go...and I guess she isnt ready to give up or she wouldnt have been full code. she has mets to brain, lungs and not sure where else...they stopped even testing for a bunch of things. the family I think is in denial. Oh the care plans I could do on family NOW THAT I think I would have much easier time....

[LVN-RNhopeful]

Protection, ineffective is in my Ackley book. My professor loves this one. Also, if you need another Nursing Dx for the family, Conflict, decisional would be a great one (another one my professor gets excited about...lol). Good luck. Sounds like a tough case.

[anangelsmommy, ADN, BSN, RN]

thanks I will look this up and see if I can find it online, I have two dx books I am not fond of the one our school had us buy and it is big and bulky but when our lpn program had us doing care plans, everyone was trying to do them out of the text book, the first thing I did was go out and buy a good care plan book, I couldnt believe no one else had one! but I am close to the end of RN program....I really dont want a third!! I am going to see If I can find this one, I may be able to even use this one on one of my next patients, I have had some doozy's lately!

thanks,

angels mommy