need help in care plan for ARF asap

[namita]

:) Hello there,

I am a LPN nursing student. I am an Asian and since English is not my Ist langauage, I am having difficulty in preparing 3 physiological nursing diagnosis and 2 psychosocial for ARF patient who has history of CHF, Chronic renal failure stage-2 :uhoh3:and has been placed on hemodialysis after hospitalization. In pt. records it states: "Anti tubular necrosis- BUN and creatinine keep rising- secondary to diminished renal perfusion." Pt. has bun = 100 and creatinine = 3.9; Also lo H&H, Low RBC's and stool tested positive for occult blood. pt has distended firm tender abdomen; pale skin, crackles in lungs, +1 edema in left hand and no edema anywhere, has paced heart rate at 79 with frequent PVC's, irregular pulse, dry skin with small round ulcers(don't know what to call them) on hands,legs and some on face, has strange body odor and has poor appetite.

I have following problems:

1- pt. is suspected to have internal/GI bleed; and my instructor said I can't use abdominal distention or pain in abdomen, coz it is related to GI bleed(which i think caused ARF in first place). I am not allowed to use lab results for 'as evident by'and can't do 'Risk for' diagnosis.

2- I cannot use diagnosis of excess fluid volume coz there is no generalized edema and Intake = 535,& Output = 1250 as O > I on day pt went for dialysis. how can i show evident of excess fluid ?

3- my teacher told me to consider elevated BUN and creatinine and its effect and then form diagnosis. I came up with these incomplete Diagnoses:

a) imbalanced nutrition:less than body requirements R/T loss of appetite(anorexia) AEB denial of hunger and observed inadequate food intake.

b)impaired skin integrity R/t accumulation of waste products(BUN and Cretinine) in serum AEB presence of skin with small ulcers (please help me to use correct term for skin condition).

C) Self-care Deficit bathing/hygiene:R/t muscle weakness caused by elevated cretinine and bun levels AEB reported inability to manage ADL's.

d) impaired transfer mobility R/t decreased strength caused by elevated cretinine and bun levels AEB inability to move from bed to chair and on/off toilet without assistance

e) moderate anxiety R/t change in health status Aeb expression "

f)powerlessness R/t loss of independent functioning AEb statement "I helped my wife....now need the help for myself"

Have to submit soon. Please help:confused: