Combined nursing diagnosis? Is it Possible...Help PlZ

[hnt1987]

My patient is going to for a colonscopy (the long word) for GI bleed

He is NPO since the night before. They gave him hypertonic laxative to clear everything out. That's fun! ^>^

They schedule the procedure at 10 in the morning. He has an isotonic IV solution running.

I came up with this nursing diagnosis. Can you help me out?

Risk for imbalanced fluid volume (hypovolemia) R/T colonscopy

Should I take the hypovolemia out? or just risk for imbalance....

I used it to describe hypo to describe my pt condition from his lab result & all that other fun stuff.

[fiveofpeep]

ehh compare I&O and the IV fluid rate because depending on the fluids and how much diarrhea I wouldnt be too worried. Maybe fluid and electrolyte imbalance (risk for) would mesh better

dont just write imbance because it doesnt specify what the imbalance is of

and I think the r/t is more r/t what you said: administration of hypertonic laxative with subsequent diarrhea secondary to colonoscopy preparation

[justme1972]

If your assignment only permits one nursing Dx and you have to come up with your interventions around that, then you come up with the PRIORITY nursing Dx....what is the most serious issue.

For example, I'm doing a psych rotation. I interviewed a lady that was depressed and suicidal. She had also lost 30 lbs d/t depression in the last 4 months...during the interview I found out she was purposely not eating in order to hopefully herself and slowly waste away.

So the depression was no longer the #1 priority, it was keeping her nutritionally balanced, as that was her #1 risk factor and directly related to her desire to die.

So my nursing Dx was:

Impaired nutrition, less than body requirements, due to severe depression related to desire for self harm.

In your situation, the bleeding and hypovolemia (which causes their electrolytes to be off) are both important....but at this time, which one is more likely to kill him?

Remember what each of your electrolytes does...and assess how bad the bleeding is...how much is showing in the occult blood...dark...bright..that tells you where vs how much.

[hnt1987]

the problem is that fluid electrolyte imbalance is not a nursing diagnosis. It is a medical diagnosis and i could not used it!

[hnt1987]

If your assignment only permits one nursing Dx and you have to come up with your interventions around that, then you come up with the PRIORITY nursing Dx....what is the most serious issue.

For example, I'm doing a psych rotation. I interviewed a lady that was depressed and suicidal. She had also lost 30 lbs d/t depression in the last 4 months...during the interview I found out she was purposely not eating in order to hopefully herself and slowly waste away.

So the depression was no longer the #1 priority, it was keeping her nutritionally balanced, as that was her #1 risk factor and directly related to her desire to die.

So my nursing Dx was:

Impaired nutrition, less than body requirements, due to severe depression related to desire for self harm.

In your situation, the bleeding and hypovolemia (which causes their electrolytes to be off) are both important....but at this time, which one is more likely to kill him?

Remember what each of your electrolytes does...and assess how bad the bleeding is...how much is showing in the occult blood...dark...bright..that tells you where vs how much.

the bleeding was gone when i was assigned to this patient. NPO before the procedure start.

his electrolytes is in normal condition, but his CBC was low b/c of GI bleeding. his nutritional status (weight) is normal.

[justme1972]

the bleeding was gone when i was assigned to this patient. NPO before the procedure start.

his electrolytes is in normal condition, but his CBC was low b/c of GI bleeding. his nutritional status (weight) is normal.

Ok...so his electrolytes were normal...which is good. I know that fluid and electrolytes is a medical diagnosis, but the s/sx that they manifest and how the patient copes with those changes are used in a nursing diagnosis.

When you say the CBC is low, which part of the CBC...look at the labs and see how the patient is acting...what is predominant? Does how the patient act match the lab?

Is the patient anxious? It could be from the impending procedure or fear of the unknown.

Is the patient fatigued? Can the patient engage in self care or is that impaired d/t the fatigue?

Patient's nutritional status will always be impaired as well as a patient having hypovolemia with doing a GI prep...always, always.

Weight may be within normal limits, but has the patient recently lost weight or gained weight? That is always a more important assessment than what the patient weights right now.

By any chance, did they have you purchase a Nursing Diagnosis handbook?

Make a list of what is wrong with your patient, and you will be able to find Nursing Dx that will fit, the general criteria for them, and suggestions on interventions.

I'll check back...

[Daytonite, BSN, RN]

NANDA clearly states that for this diagnosis you can say Risk for Imbalanced Fluid Volume R/T scheduled colonoscopy.

Hypovolemia occurs specifically because of blood loss. You did not mention that this patient was bleeding or hemorrhaging. I think what you mean to say is dehydration. Your nursing interventions would address how you will prevent the patient from becoming dehydrated. You do it by monitoring for its signs and symptoms.

[KarmaInMotion]

If I understood, your pt is getting the procedure b/c of evidence of a GI bleed? Just wanted to add, b/c the pt's colon has been cleansed and is NPO, does not mean the bleading has stopped. This just means there are no food substances present to help the blood show up and be observed - at this moment. Unless the procedure was b/c of a suspected GI bleed based on CBC and other S/Sx? If only suspected, then I might try another Dx with more supportive info. Just a thought ...