First care plan! Help! Necrotizing pancreatitis

[SEM0627]

Hi! This is my first post on here, and my first real care plan ever :)

My patient's diagnosis is necrotizing pancreatitis; he had an exploratory laparotomy and pancreatic necrosectomy a couple months ago. He has an enterocutaneous fistula that is not healing because even though he is NPO, he sneaks food and coffee frequently. He's remaining in the hospital voluntarily because he admits he would not be compliant with his NPO status at home (although he's not exactly compliant at the hospital either!). He has no visitors and tends to isolate himself. He has bilateral edema in his calves and feet.

For our care plans, we can't use pain, tissue integrity, or any at risk diagnoses. We have to list two etiologies and include a "secondary to" for each one. Yeesh!

These are the possible nursing diagnoses I've come up with:

- Social Isolation

related to absence of satisfying personal relationships, secondary to absence of significant others

related to alterations in physical appearance, secondary to weight loss.

- Excess fluid volume (but I have no idea what my etiologies would be for that, because I don't know why he has edema)

- Ineffective health maintenance,

related to deficient knowledge concerning his NPO status, (Still trying to figure out my "secondary to"!)

related to social support deficit, secondary to lack of family support

I'm lost. Help!

[LiveYourDream]

Hi - Im a student too. Just some possible thoughts, till someone else who knows much more replies :)

For the edema I think you would be better off with decreased tissue perfusion than excess fluid volume, since youre describing peripheral edema. As far as secondary to: Is he on bed rest? If not, has he been ambulating? Does he have any chronic conditions that decrease perfusion such as hypertension or diabetes? Is he on any meds that could cause edema?

Also similar to your idea, you could do something about ineffective management of therapeutic regimen since the NPO is to rest his system and he is having a hard time complying.