Need help STAT

[bellagrace903]

hello. i have a discharge paper due tomorrow with all kinds of stuff required for it. i just found this site- graduating in may- wish i'd found it sooner! the following is what i need help addressing. to start off, here is the assessment data:

t-97.7°f p-78 b/p-130/79 r-18

neuro- decreased motor strength, intermittent confusion; resp- diminished breath sounds; cardio- edema +1 in l&r legs; eent- blind due to cataracts; gi- wnlx obese; nutrition- wnl gu- wnlms- generalized weakness; +1 edema in r&l legs; skin- cool, flaky, pale, lower legs; red and warm to touch; no pressure ulcers; open wounds on l&r lower legs with ace bandage dressing; fall risk- bed alarm, star on id band; skin risk screen- at risk with appropriate bed; last bm 1/27/09; history of schizophrenia- looseness of associations; pt denies pain unless lower legs/feet are touched; pt needs assistance with bathing, toileting and preparing meals; pt is poor historian of self and has difficult answering direct questions; toenails 1-2 inches in growth, unkept, need trimming; pt refuses physical therapy

medical dx: bilateral cellulitis

lab data:

in this order: test, pt. results , normal results, implication, nursing intervention

glucose fasting, 110 h, 60-110mg/dl, increased with diabetes mellitus, use sliding of insulin and administer dose.

rbc, 3.43 l, 4.2-5.4 x 10^12/l, decreased with anemia, teach patient to include iron-rich foods such as red meat, raisins, green leafy vegetables in diet.

hct, 34.6 l, 35-47%, decreased with anemia, teach pt to include iron-rich foods such as red meat, raisins, etc.

mch, 34.0 h, 28-33uug/cell, increased with anemia, teach patient to include iron-rich foods such as red meat, raisins, green leafy vegetables in diet.

mono %, 13 h, 2-8%, increased with infection and collagen disorders, administer prescribed antibiotics as ordered.

mono k/ul, 0.9 h, help!, help!, help!

please feel free to add to anything i already have. i have searched the internet, called classmates, and looked in my book for the mono k/ul normal values, indication, etc and can't find anything. no, i do not have a lab book (not required and can't afford school as it is!)

the next part i need help with is nursing diagnoses and rationales. i'm not the best at this and i can word awkwardly sometimes so any help- add/subtract/etc with these would be greatly appreciated. i feel like some are very redundant so if something else is better as r/t or aeb, please let me know! also, if you can think of more, that'd be great.

ineffective tissue perfusion r/t impaired circulation aeb lower extremities warm, tender to touch and +1 edema.

palpate the dorsalis pedis pulses in both feet, use a doppler if indicated.

elevate the legs above the heart level. be sure not to apply pressure to the open wounds.

measure the circumference of both legs and be sure to mark the site to facilitate accuracy of recordings.

monitor and record daily weights and intake and output.

impaired physical mobility r/t pain in legs aeb refusal to participate in pt session.

promote exercise

thromboembolus precautions

pressure ulcer precautions

risk for disuse syndrome r/t inability to ambulate aeb refusal to participate in pt session.

promote exercise with strength training

impaired skin integrity r/t open wounds aeb warm, red, tender to touch extremities.

skin care- topical tx

wound care

!! not so sure about this one!! acute pain r/t (infection?!) aeb pt requesting pain rx after dressing changes.

pain mgmt

infection r/t medical diagnosis (do i write that or put the actual diagnosis or what?!) aeb lab results (should i list the applicable ones here?) and strong, foul odor from legs

protection

risk for imbalanced nutrition r/t immobility and blindness aeb..... ?? (she's obese)

nutrition mgmt

ineffective peripheral tissue perfusion r/t --ok, i got stuck here!--

circulatory care: arterial insufficiency

circulatory precautions

activity intolerance r/t ---stuck again... i feel too redundant?!---

exercise therapy- ambulation

risk for constipation r/t immobility aeb need for milk of magnesium

impaired respiratory function r/t immobility aeb diminished breath sounds

thank you for any input!:)

[avatar78]

The monocyte number you're looking for is the SI unit versus the % that is given. It's high both ways. Normal in my book is 0.02-0.08x10(to the 9th)/L.

[bellagrace903]

Thank you! I'm guessing the same implication and nursing intervention would apply! :heartbeat

[Daytonite, BSN, RN]

I didn't see your same post of this in the General Nursing Student Discussion Forum until late last night and I am on the Pacific coast. I looked at it quickly and saw that your nursing diagnoses needed a lot of corrections. I couldn't figure out what the first half of your post was asking. I had doctor's appointments this morning and I had to go to sleep. When I got back from my appointments late this morning I spent almost 4 hours working on a answer for you. It is posted on the General Nursing Student Discussion Forum. If you post future questions on this forum I will get to them faster since I go to this forum first each day.