Care Plan Help-Liver Cancer and Cardiogenic shock secondary to SVT.

[ericamarr]

Hello. I am currently doing a care plan and need three priority NANDA nursing diagnosis for my patient. Your help would be appreciated! :)

Here is my patients situation: On 11/15/18 patient was on the way to the emergency room due a clogged suprapubic catheter (He got this ten your ago due to urethral stenosis). On the way to the emergency room he started feeling lightheaded and having palpitations. Patient was previously diagnosed within the last few weeks of atrial fibrillation. When patient arrived at the emergency room, he started having some chest discomfort and dizziness. He was found to have supraventricular tachycardia and was given 2 rounds of adenosine, amiodarone, and then cardioversion with 120 joules. Patient was having significantly low blood pressure with the SVT. Patient was diagnosed with cardiogenic shock secondary to SVT. This was reversed in the emergency room following cardioversion. Patients catheter was unclogged in the emergency room. Patient had also had a CT of the abdomen performed due to elevated bilirubin and liver function tests. This was a new finding for the patient. The CT of the abdomen showed multiple liver masses suggestive of metastasis the largest being up to 7 cm. There were bilateral pulmonary nodules compatible with metastatic disease the largest at 15.2 mm. There was a 2.5 cm omental mass as well as some sigmoid diverticulosis. Patient reports never having a colonoscopy in the past. Patient stated he has lost 7 to 8 pounds in the last month.

[JKL33]

What diagnoses have you come up with so far?

[ericamarr]

These are some of the nursing diagnosis I have come up with so far.

1. Infection R/T liver cancer, decreased WBC, low hemoglobin, and refused influenza and pneumonia vaccinations, and increased environmental exposure to pathogens.

2. Risk for decreased cardiac tissue perfusion R/T hypertension, obesity, and decreased hemoglobin.

3. Anxiety R/T change in health status

4. Risk for decreased tissue perfusion R/T hypertension and obesity

5. Risk for decreased gastrointestinal perfusion R/T hypertension, liver cancer, and being over the age of 60.

Thanks for your help! :)

[Triddin]

I wouldn't say infection is a current priority based off the evidence offered. It sounds more like a " risk of" at best. Low hgb really has no bearing on infection, neither does liver cancer, unless he is being treated with chemo and has become immunocompromised, and you would expect end to be elevated if there was an infection.

Your #2 and 4 are essentially the same. How does obesity cause poor tissue perfusion? I don't this it provides strong evidence. Same with number 5. I don't think you are providing strong evidence there is low perfusion, I would expect to see hypoactive bs, decreased motility as evidence.

With the minimal information given, I would focus on nutrition, effects of liver cancer, low hgb to be priority problems, how is his cardiac stuff since he's been cardioverged? And kidney effects from being obstructed? I feel those would likely be more pressing problems

[emmjayy, BSN, RN]

With liver patients, keep an eye on the CBC, particularly H&H/platelets. See if there's an ammonia level checked as well. Those numbers might lead you towards more applicable nursing dx.

[ericamarr]

*** I meant to put RISK FOR infection R/T liver cancer, decreased WBC, low hemoglobin, and refused influenza and pneumonia vaccinations, and increased environmental exposure to pathogens.

[JKL33]

Disregard the duplicate post. See below...

[JKL33]

erica, I think you need to hone in a little bit. Your proposed diagnoses are very broad and non-specific.

Start with basic facts you know:

- The patient has lesions consistent w/ liver metastases of unknown primary origin, and elevated LFTs

- The patient has pulmonary nodules c/w mets of unknown primary origin

- The patient has recent unintentional weight loss

- The patient has just a had a change in cardiac-related health

- The patient has just received a potentially life-altering diagnosis

- Your patient has a suprapubic catheter r/t a long-standing urologic problem

- Other facts you may know based on info not posted

*

Basic questions you could ask yourself (by no means all-encompassing/inclusive) -

- What are the effects of altered liver function; does your patient's picture show any of these?

- Why is your patient anemic - does your patient's exam or recent history give you any clues about this? Is your patient manifesting any effects of anemia?

- Any respiratory changes?

- Your patient does have some risks for infection; what are they?

- How is your patient coping/what is the response to this news?

- Why has your patient lost weight?

These are just to get you started. Examine every aspect of your patient's history and present situation. What caused these things and, in turn, what are their effects?

[LovingLife123]

OP, what is the priority at this moment? What is going on with the pt right now?

While the pt does have a risk for infection, that's not your issue right now. If you had this pt in the ER, what are you going to worry about and treat? And why are you going to treat this issue?