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Discussion

Care Plan Help Please

Hello all,

I am hoping to get some help with a care plan. I am in my second semester and my teacher is really expecting us to know what we are doing now...and I really need some assistance with this patient please!! :confused:

58 year old male, admitted with syncope r/t defibrillator failure (they called it defib syndrome on his admission forms, but I think that may be something else), he also has Diabetes, COPD, Depression, Arthritis (mainly in hands), elevated Cholesterol, CHF, and the defib was inserted after two MIs. O2 was 93% room air, Blood Glucose was 157 (before breakfast), BP 135/75, 68bpm. He is noncompliant w/diabetic diet aeb pt stating he knew his eyesight is declining rapidly and he "can't stay away from pasta"; he presents with slight edema in ankles and feet; Protime was 29.4 sec, BUN 26mg/dl, chest x-ray only states "maybe some medial pleural calcifications on left"; pt has no chest pain; BMI 39. Oh, and his ECG shows afib, with no T wave.

Sorry, this is a lot of info...but I don't know what to focus on. We need 5 dx's for each careplan.

If the BP and HR are within range, can you use Decrease Cardiac Output r/t defib failure aeb ECG results? I think I should also use Ineffective Tissue Perfusion r/t CHF aeb edema?

All suggestions are welcome & will be appreciated! :D

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    Oh, and I think I will also use the Noncompliance dx and a Depression one, maybe Ineffective Coping (the pt is depressed b/c of illnesses)

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    well if he had a sycopal episode due to failure of his implantable cardioverter defibrillator (icd) then a good rn dx would be:

    decreased cardiac output r/t dysrhythmia

    ineffective tissue perfusion: cerebral r/t interruption of blood flow.

    risk for fall or risk for injury

    copd:

    impaired gas exchange r/t ventilation-perfusion inequality

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    Maybe deficient knowledge as well? There's always something you can teach a patient.

    Here's some DM-related ones, since that is a major illness that touches so many arenas in a patient's life:

    1. Risk for unstable blood glucose level r/t (inadequate blood glucose monitoring, dietary intake, medication management)

    2. Risk for infection r/t chronic disease process (diabetics have a horrible time in dealing with infections, especially in their extremities).

    3. Risk for impaired skin integrity r/t (altered circulation, edema, fall risk?, etc)

    4. Fear r/t (recurrence of disease, unfamiliarity with therapeutic regimen, loss of sense of control)

    5. Powerlessness

    That was five just related to diabetes! Your guy also has COPD, depression, arthritis, history of cardiac disease, dysrhythmia...

    When prioritizing, remember ABCs.

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