I need help to choose 3 priority nursing diagnoses for this patient : Scenario '' 32-year-old woman being admitted to the medical floor for complaints of fatigue and dehydration. While taking her history, you discover that she has diabetes mellitus and has been insulin dependant since the age of 8. She has undergone hemodialysis for the past 3 years. Your initial assessment reveals a pale, thin, sligthly drowsy woman. Her admitting chemistry are Na 145, K 6.0 , Cl 93 , HCO3 27 , BUN 48 , creatinine 5.0 , glucose 238. Her skin is warm and dry to touch with poor skin turgor, and her mucous membranes are dry. Her VS are 140/88, 116, 18, 99.9F. She tells you she has been nauseated for 2 days so she has not been eating or drinking. She reports severe diarrhea. Serum Ca, PO4, and Mg have been drawn but are not yet available.
Case study progress: The rest of physical assessm. is WNL. she tells you she has an AV fistula in her left arm.
Case study progress: Over the next 24 hrs., her nausea subsides and she is able to eat normally. While you are helping her with her AM care, she confides in you that she doesn't understand the renal diet. '' I just get blood drawn every week and meet with the dialisys dietitian every month - I just eat what she tells me to eat.''
Case study progress: CBC result: WBC 7.6 , RBC 3.2 ,Hgb 8.1 ,Hct 24.3 , and platelets 333.
Jul 29, '10
1 Deficient Fluid Volume ( Isotonic) r/t excessive loss and inadequate fluid intake, as evidenced by increased pulse rate, increased T, decreased skin turgor, dry mucous membranes, change in mental state.
2 Imbalanced Nutrition: less than body reguirements r/t inability to ingest nutrients bacause of nausea as evidenced by reported inability to ingest food, diarrhea.
3 Diarrhea r/t malabsorbtion as evidenced by reported severe diarrhea.
These are my ideas. Please, I need a second opinion.