Care Plan Help/Necrotic Ulcer

[GAA30]

Guys, I need your help. I have a careplan to do on a patient with chronic renal failure who developed an ulcer on his fistula. I am lost. Care plan due Tuesday,please help!!!!!

[Daytonite, BSN, RN]

a post op patient in general may or may not have some of the following problems:

• surgical pain
  
• breathing problems
  
• thrombophlebitis of the lower extremities
  
• elevated or depressed temperatures
  
• problems with the incision(s) (dehiscence, evisceration, infection)

cabg patients, in particular may have

• arrhythmias
  
• swelling or aching of the leg(s) where the donor vessel was taken as well as decreased sensations or numbness in those limbs
  
• pain over the sternum

here is information on cabg:

• http://www.nlm.nih.gov/medlineplus/tutorials/coronaryarterybypassgraft/ct039103.pdf - coronary artery bypass graft

i'm a little confused here. are you being told that the patient has some kind of problems with the central line, cannula site, pacing wires and chest drain site? if not, i wouldn't assume these things. what i tell other nursing students is to take medical information you are given, list the normal symptoms the doctor would expect to find and extrapolate nursing interventions from those symptoms because nurses can also treat the symptoms--not the medical disease.

my suggestions would be to work with the following problems for this imaginary patient (unless you've got other information you've been given that you haven't told me about):

• surgical pain
  
• presence of an incision over the sternum
  
• has just gone through detox of some substance

for these i would use the following nursing diagnoses:

1. impaired skin integrity
   
2. acute pain
   
3. acute confusion (this would be due to withdrawal) or you could also use disturbed sensory perception if the patient is going to be hallucinating

for impaired skin integrity two goals that you could use are:

1. in one month the midsternal incision will be completely healed.
   
2. by the day of discharge from the hospital the patient will demonstrate the proper way to cleanse and redress his/her midsternal incision

i can't think of a third one at this moment, but this is your assignment.

hope that helps you out.