Patient was 29 yr old with End Stage Renal Disease. She did her own peritoneal dialysis at home for past 2 years and did it for herself in hospital. She was in hospital for a total parathyroidectomy due to hyperparathyroidism. Her calcium levels remained low (considered critical levels by lab standards). No symptoms of the hypocalcemia were present. I have several diagnosis but can't seem to put them in order of priority.1. impaired tissue integrity - due to the large, slight swollen incision on neck from surgery2. risk for ineffective airway clearance r/t edema (of surgical site)3. risk for injury r/t effects of hypocalcemia4. risk of fluid volume excess r/t renal impairment OR retention of dialysalate OR compromised regulatory mechanism5. risk for infection r/t surgical procedure6. risk for infection: peritoneal r/t presence of catheterI understand that airway is always first but this is just a "risk" as opposed to other things that are actually happening. The low calcium seems like a really big deal to me but when I look in my care plan books at Nanda wording and interventions - there just doesn't seem to be many true interventions other than administering the prescribed meds, teaching, and monitoring for complications. So, would you use the hypocalcemia (how would you word your diagnosis), or the surgical site tissue integrity, or the airway risk (since airway is always a priority - pt had slight swelling, a small amount of swallowing difficulty but lung sounds were normal, even, clear, etc. .... Please help me --- Due 8:00 in the morning!!!
