Care plan for pt. with syncope, diabetes, copd and more

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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

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)

I'm just not sure what my first three s/b.

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

you have to start with your ABC, does your patient have a problem with airway? does he have a problem w/ breathing? i would think so since he has a hx of COPD so your 1st dx would probably be ineffective breathing pattern, r/t --- impaired gas exchange. and circulation -- he definitely has a problem w/ circulation because of his syncopal episodes and because of his heart condition he's not perfusing his brain hence the syncope so your 2nd priority dx is impaired tissue perfusion , also due to DM he's not perfusing his extremities very well, as well as his other organs i.e. kidneys, i would think he is experiencing neuropathy, you just have to know your r/t and also due to his CHF yes you're right. the eyesight problem is also due to his DM. so you can also do impaired sensory perception or something about blindness, -- then you go with pain -- i would think since he has athritis that he has chronic pain. then you can put the psych dx depression, etc.

hope this helps.

Thank you for your help! I will use ineff tiss perf r/t disrythmias, impaired sensory:vision r/t DM, Noncompliance r/t DM, Ineff coping r/t chronic illness, and Risk for Falls r/t syncope.

How does that sound?

And I did not use your other suggestions only b/c he did not complain of dyspnea or SOB and his O2 was normal. Also, he did not have neuropathy in any extremities, only had the diminishing vision b/c of DM, so I wasn't sure if I should use neuropathy. But I thought the noncompliance supported by what could happen in the rationale would be a good idea.

Thanks again!!:yeah:

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