Hey guys! I need major help with my care plan!
This is my second care plan; and I'm having trouble figuring out which d/x I should use and im concerned that im not making the right choice or that I'm not seeing something incredibly obvious.
I have a 60yo man. admitted for GOUT attack and AKI.
He has acute kidney injury (AKI), bipolar depression, hypertension. very severe GOUT, hyperlipidemia, cirrhosis of the liver r/t alcoholism (pt. stated he is now sober though and has been sober for a few years), he also has hepatitis C, and type 2 DM.
That being said, his DM is well managed without the use of insulin or oral antidiabetics (he manages it through diet evidently). The pain he was in was almost unbearable for him, he literally did not get out of bed all day. He is ordered pain meds BUT they only seem to help him IF he keeps still (pain level at a 3/10); but once he moves, his pain levels increase to like a 6/10 while medicated. He can barley move at all because of the GOUT (its affect mainly his L arm but it seems to have spread down the whole R leg, so even changing positions in bed seems to be a battle for him).
His vitals were all unremarkable, BP 136/60, P 64, T99.7, R24 and O2 was at 97 RA. lung sounds clear but diminished in bases. His H&H and RBC were low, all his specific WBC values were increased, BUN/creat were increased, uric acid was high, total protein and albumin were both low.
SO I feel like the d/x could be: ineffective renal tissue perfusion, decreased CO, impaired mobility, or acute pain.
I was just working on the ineffective renal tissue perfusion BUT then I hit a wall and am now second guessing myself BECAUSE I feel like my pt's AKI is a problem r/t decreased CO. So if I'm going to make something a priority, shouldn't it be decreased CO?
I really would appreciate some guidance or advice because i'm definitely confusing myself right now and don't know where to start! and because this is my second care plan, I really want to make this a good one; not a little dinky one.