careplan

OK so I had a patient with a diagnosis of Adenocarcinoma of the GE junction with CNS metastatic disease. I have to have four priority nursing diagnosises. This patient's RBC are 3.35 WBC WNL and all other labs that are abnormal are by a point or less off from normal... Even though there is no normal in nursing school lol!

1.

2. Imbalanced nutrition r/t.... AEB TPN.

3. Alterations in Urinary Elimination r/t fluid retention AEB low Urinary Output.

4. Imparied Physical Mobility r/t post opt weakness secondary to metastatic disease weakness.

My question is this. My nursing instructor said that his primary diagnosis should be infection??? He had a Laprarotomy on 8/15 because he originally came in with a perforated colon? This was fixed and his staples were removed 3 days ago. He is receiving a few antibiotics however his WBC count is WNL... he is and has been defecating without any issues. He is not receiving Chemo or radiation at this time and his cancer is not staged. So is infection really my top diagnosis when I have no labs or physical evidence (i.e fever and VS) to prove he has an infection?? I understand his immune system is compromised but a "risk for" cannot be my top diagnosis. Also his Imbalanced nutrition LTBR r/t.... AEB TPN. Im stuck on this one.. He has horrible ulcerations of his mouth however this doesnt keep him from eating but he does have an altered taste with food. How do I write this careplan i have never been so stumped! Please any advice is welcome!!!