Help w/NCP

Jolie, BSN · Feb 27, 2004

What about addressing comfort measures. If I were that patient, comfort would be my first priority!

unknown99, BSN, RN · Feb 27, 2004

I am not trying to be mean or anything, and I know how you feel, I've been there. Your instructors did not guide you for a reason. They want you to figure it out for yourself, plus it appears that they have the confidence that you will do so. I will give you a hint though. Think of the A.B.C.'s of patient assessment. What would be the first thing you would assess ANY patient for?

Well , goodluck, and let us know how you do!!!

zacarias, ASN, RN · Feb 27, 2004

Man, if that guy is not on the transplant list, he is not long for this world sorry to say!! I look at all of his problems and my first concern would be his bleeding. He's got anemia and tarry stools. Bleeding from GI tract due to Portal Hypertension. Go from there.

You didn't say anything about his renal function but I bet it's weak.

SnowymtnRN · Feb 27, 2004

ABC's. Since Airway, Breathing isn't an issue (yet) then circulation. Since circulation is not the main focus (cardiac) then what's the MOST life altering disease process he's presenting? I'd say ESLD, then ascities. But that's me. Good luck!

leslie :-D · Feb 27, 2004

sepsis would be the most urgent one.....the anemias, ascites and other hepatic events are all a part of the bigger picture that will need more intricate planning. ncp's will then depend on whether he is made comfort measures or put on a transplant list. but even in the short term, the anemia and ascites will both impact his breathing, so of course, they too would take priority. good luck.

jlynnRN · Feb 27, 2004

Thanks everyone for your advise. I realize remember the ABC's but when you have a vit. k deficiency/hemmorrhage, anemia, & sepsis. Which one should be addressed 1st was the problem. I get so confused with people like this guy, he's got a whole bunch of probs that are all pretty serious. Thanks again.

SnowymtnRN · Feb 27, 2004

crap. i missed the sepsis dx. The pp is right, i'd go with sepsis first. lol PREGGO BRAIN!!!

leslie :-D · Feb 28, 2004

Thanks everyone for your advise. I realize remember the ABC's but when you have a vit. k deficiency/hemmorrhage, anemia, & sepsis. Which one should be addressed 1st was the problem. I get so confused with people like this guy, he's got a whole bunch of probs that are all pretty serious. Thanks again.

God, i remember all the anxiety these ncps caused me in school. jlynnrn, try to put it in perspective. his k deficiency and resultant hemorrhaging and other low blood counts definitely impact his breathing, part of the abc assessment. since he's profoundly anemic, he's not getting adequate o2 so that would be a part of your abc assessment since the anemia is clearly impacting his breathing. the sepsis and uncontrolled bleeds are in the top 2 of physiologic priorities.

SnowymtnRN · Feb 28, 2004

Yeah they used to totally freak me out too. Not because i didn't understand, but because the darn teachers would just COMB over them with a fine tooth comb and nit pick them to death. Good luck!