Need help with nursing diagnosis *thanks*

[bugcompany]

I have had a million things going on in my head and its making me get so confused I decided I would ask for help.

My pt is 78 latino male with 5 children. Widower, retired. His daughter is getting married in one month.

He has meta lung cancer dg 1 year ago and just got last treatment of chemo a month ago. He has hard nodules over back,hip,leg mainly on left side: where some are hard and dried over and others are pusy and painful to touch. From 3/10 to 8/10 depending on medication dosaging. He is on a PCA pump. Pt refused to sign a DNR but stated its in Gods hands and he has given up. Refused chaplin services. Pt has 60 pack years, his respirations were labored, and had crackles and wheezes bilaterally. He is on 3L 02 with SP02 of 98. Yet his labs show his hemo, hema, RBC were low. Also his neutrophils were high lymph low. His calcium was high phosphorus was low. His WBC and platelets were Within normal limits.

The patient doesn't appear to have any cardiac problems. He has been nausea and vomiting for 3 days prior to admission and hasnt be able to keep medicines or food down. He is on dex 5 for caloric replacement.

He has had elimination needs, where he has been constipated and when we did enema and laxatives he strained to go and it was very hard the stool.

the nurse nor instructor indicted whether or not he is pallative or medical care. The only drugs he was on were for n/v and nothing for the high neutrophils.

He was blood typed and cross match which indicates they potentially could be trying to do a blood transfusion for the anemia or maybe even bone marrow which seems a waste at this point.

So basically my nursing dg are pain, respiratory, n/v, anemia, infection, anxiety, elimination needs and spiritual distress. I just can't decide which one is a top priority in order.

I just can't figure out what would you rank because of not knowing if its pallative or medical care. If its pall than pain if not respiratory???

Thanks so much.

Love Sarah Johnson TN

[vashtee, RN]

I was taught that ABCs are always the first priority, so I would do respiratory first...

[Daytonite, BSN, RN]

so basically my nursing dg are pain, respiratory, n/v, anemia, infection, anxiety, elimination needs and spiritual distress. i just can't decide which one is a top priority in order.

i've had cancer 3 times. if he refuses to sign a dnr, he wants to live. the fact that he just completed chemo tells me he's determined to fight the cancer. chemo is the pits, believe me. it stinks. and just going through it is proof enough that he is not closed the book on his life yet.

i would prioritize by maslow:

1. respiratory (need for oxygen)
   
   
2. anemia (need for oxygen and nutrition, combined)
   
   
3. n/v (need for nutrition/fluids)
   
   
4. elimination needs (need for elimination)
   
   
5. pain (need for comfort)
   
   
6. anxiety (need for security)
   
   
7. spiritual distress (need for self-actualization)
   
   
8. infection, risk for (
   anticipated
   need for protection)