help with careplan

[aixa]

I am having trouble figuring out what nursing diagnosis to use for a 77y/o patient who was admitted for dehydration, ARF and hyperkalemia, however when I met him the K+ was WNL and voiding freely. He went in for weakness and inability to walk. During the time I was there he was scheduled for TEE therfore was NPO. No IV fluids (though IV bicarb was ordered) which I know is to treat the increased K+ levels (though resolved). The only abnormal labs were increased BUN(48) and creatinine(1.74) which I understand can be caused from dehydration however like I said he had not been getting fluids and was stable. I was leaning towards diag #1 Ineffective renal perfusion r/t hypovolemia aeb increased creatinine and BUN and diag#2 Risk for decreased cardiac output r/t possible dysrhythmia secondary to increased K+ levels aeb compromised regulatory mechanism. (Is that way too Long diagnosis). Help me Daytonite!!!!

[~Mi Vida Loca~RN, ASN, RN]

I am having trouble figuring out what nursing diagnosis to use for a 77y/o patient who was admitted for dehydration, ARF and hyperkalemia, however when I met him the K+ was WNL and voiding freely. He went in for weakness and inability to walk. During the time I was there he was scheduled for TEE therfore was NPO. No IV fluids (though IV bicarb was ordered) which I know is to treat the increased K+ levels (though resolved). The only abnormal labs were increased BUN(48) and creatinine(1.74) which I understand can be caused from dehydration however like I said he had not been getting fluids and was stable. I was leaning towards diag #1 Ineffective renal perfusion r/t hypovolemia aeb increased creatinine and BUN and diag#2 Risk for decreased cardiac output r/t possible dysrhythmia secondary to increased K+ levels aeb compromised regulatory mechanism. (Is that way too Long diagnosis). Help me Daytonite!!!!

Daytonite passed away last year

https://allnurses.com/general-nursing-discussion/daytonite-has-passed-476765.html

[CBsMommy]

Did the patient have a dysrhythmia? It states a possible dysrhythmia? Was the patient hooked up to an EKG? What were the readings?

If the patient was dehydrated they most likely had decreased cardiac output r/t hypovolemia.

Are you doing your care plan based on when the patient was admitted or the patient's current status?

You are on the right track though!!!!

[CBsMommy]

You know...I would also address the reason the patient was dehydrated. What was their status prior to the dehydration? Were they impaired prior to the dehydration? If someone cannot complete their ADLs (they are immobile or have impaired immobility or impaired cognition), they might not be able to get to their water source or might not be able to even state (or know) they are thirsty. When people age (as I'm sure you know) they already have an impaired thirst mechanism. Did this person come from a nursing home? Any history of dehydration or UTIs prior to this incident? This might be something to consider for a long term goal for the patient...ie. patient to drink 6 ounces q2h while awake.

Just something to think about!

[aixa]

Well that is where the confusion is. I dont know if I should do it based on the admitting diagnosis ( ARf and the hyperkalemia) or on his current status. Like I said his K+ levels were WNL, no IV drips infusing, nor any cardiac monitoring, VS wnl. Only his creatine and BUN were still elevated suggesting the renal impairment was not fully resolved. So i thought I would do "Risk for" diagnosis'.based on his admitting diagnosis if possible. However the only current abnormalities are the BUN and creatinine and for that I could only think of "Ineffective tissue perfusion". In response to the dehydration , no h/o UTI but he had been hospitalized 6mos ago for dehydration and he reported not drinking enough fluids very matter of a factly. Patient is rather active, lives alone (wife died 3 mths ago) I'm sorry to hear abot daytonite.