I need thoughts on a case study

[morningstarRN, RN]

Hello all:

This is my third case study and I had a few questions. I am using the Cox nursing diagnosis text as my reference for this study. I have to choose two different diagnosis for this study. I have chosen Tissue perfusion ineffective and Health Maintenance Ineffective. We are supposed to use the one that takes priority as the first diagnosis in our paper, so that would be tissue perfusion rather than health maintenance.

Here is some of the background information on the client: She is 70 years old. Uses a walker, limps, is dirty, feet are very edematous and wrapped in dirty dressings, and covered in animal hair. She has lost 8 lbs in less than 3 wks. Vitals are all within usual limits but temp. is slightly elevated at 99.5 (F). Upon examination the client is found to have ulcers on both heels that are 1x2 cm and draining serous fluid. The client states that she was instructed to soak her feet in Epsom salts and warm water but doesn't have a basin or Epsom salts. States that she is simply wiping them with iodine once a day and that she feels this is sufficient as that is what her mother used to do with wounds. Pedal and tibial pulses are absent bilaterally. Skin on feet is cool and pale, and toenails are thick and overgrown. Patient also states that she doesn't like to cook and she doesn't care for the meals her daughter provides. States that she tries to drink four glasses of water a day to help with her constipation.

This all of the background I have. I am having a difficulty with finding the etiology for Tissue perfusion ineffective. I thought about dehydration but it seems that if dehydration were the cause that the blood pressure would also be lower. I am not finding any indication of a cardiac or blockage issue leading to perfusion issues by reading the background on this client. I feel that ineffective health maintenance is a more fitting diagnosis but am concerned that it does not have priority over the lack of circulation to the clients feet.

I hope that made sense, I am terrible at explaining things online. Anyway, any thoughts would be welcomed.

[*M_o_n_i_c_a*]

Hi i did a case study recently about a man with PVD and the nursing diagnosis was Ineffective peripheral perfusion. In this case i would say this is evidenced by the lack of palpable pulses, cool and pale skin and edema. It might help to look up PVD for some ideas maybe. Do you know if she has diabetes?