help please....care plan request......

[yatyu]

Here is the basic information.

Mr. Lau 92 year old

Diagnosis : liver failure & Hepatic cellular carcinoma

Chief complain : Right upper quadrant pain

Risk :

Nutritional imbalance

- encourage food intake

- high protein gastric diet (Ensure 2 cans per day)

Problem :

1. Edema

-exercise

-raise leg

-measure the circumference of calf QD

-limit water intake

- monitor I &O

2. Abdominal pain

-refer the complaint of pain to MO (no analgesic prescribed)

- positioning

- access the pain level, nature, positioning, onset, etc.

Where should I start???confusing now..

[yatyu]

As I am working on risk for imbalance nutrition, I want to ask how could I determine the ideal weight? or just maintain his current weight? thanks!

[Daytonite, BSN, RN]

oncology was not my field of nursing. i recommend that you consult with a dietician or do some reading in a nutrition textbook. what i know, in general, is that cancer patients have a difficult time maintaining their weight as their disease progresses because the exponential growth of the tumor(s) require massive more amounts of nutrients than the patient normally ingests orally. in addition, the patient has pathology in the gi system that is likely to disrupt the digestive process. if he is having any nausea there is going to be difficulty getting him to eat at all. it would probably not be realistic to expect him to gain weight back and a huge chore getting him to even maintain his current weight.

[yatyu]

Thank you~sorry~I aslo want to ask is his anemia related to nutritional deficiency?

[yatyu]

oncology was not my field of nursing. i recommend that you consult with a dietician or do some reading in a nutrition textbook. what i know, in general, is that cancer patients have a difficult time maintaining their weight as their disease progresses because the exponential growth of the tumor(s) require massive more amounts of nutrients than the patient normally ingests orally. in addition, the patient has pathology in the gi system that is likely to disrupt the digestive process. if he is having any nausea there is going to be difficulty getting him to eat at all. it would probably not be realistic to expect him to gain weight back and a huge chore getting him to even maintain his current weight.

so what should i put in the goals of intervention? slow the process of weight loss?? thanks!

[Daytonite, BSN, RN]

i don't know what's going on with this patient like you do. you need to look at his labwork, the history of his disease and the treatment he's received. the reason for his anemia may be unknown. my guess is that it is related to his liver pathology, not nutrition.

as i said, with regard to the nutrition, i would either talk with a dietician or look at some nutrition resources to find out about nutrition, weight loss and weight gain in cancer patients. then, you will have a better idea of what kind of nursing interventions and goals to develop.

here are links to two sites that have outcomes (goals) and nursing interventions on them for the diagnosis of imbalanced nutrition: less than body requirement. perhaps you will find some useful information there that you can use in the care plan for this patient.

http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=37

http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_049.php