NCP Help Please

What exactly are you asking? NANDA dx? What do you think is appropriate/relevant? Low H&H, low BP, s/p abdominal surgery, etc. You should address the A, B, Cs first. Think of Maslow.

I am asking help with formulating goals for my nursing diagnosis of deficient fluid volume related to blood loss during cesarean section. The assessment data I listed was what I had to support my diagnosis. I understand ABC's, I was just having trouble with a goal.

These things drove me nuts in school...but this may help.

1) what is going to kill your patient first? It's easy to get into "fluid volume deficit" but why is the patient running a deficit, and and a deficit of what? BLOOD. You know what a 1000 cc bag of blood looks like. That's at least how much she's down.

Goal? Replace the blood. You can put something like "normotensive blood pressures" but to get to that goal of a normal blood pressure, you have to realize that she's only sating 99% on room air because she's got extra circulatory RBCs in her remaining volume to begin with due to the pregnancy. You take a 1000 cc blood loss on top of a 2600 cc deficit, that's potentially fatal hemmorhagic/hypovolemic shock waiting to happen.

What I'd do real world (keep in mind I'm not L&D, I'm ICU, L&D may be different) -- get a bag of LR going wide open to get the volume back up. See if the doc wants PRBCs or hespan, since any fluid replacement is going to drive the hgb even further down, plan on hanging at least 2 or 3 units as fluid replacement tanks the hgb, and you need something going until the blood's ready from the blood bank. You've got to get the Mean Arterial Pressure above 60 if you want her to perfuse her kidneys (remember the almost anuric urinary output?), so maybe that could be a goal?

To me, ABC just makes me hear Michael Jackson singing the song. I always think, "What's going to kill them first?"