Nursing care plan due Wednesday PLEASE HELP ASAP

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the pt I am doing a care plan on has a perianal abcess and colovesicular fistula. The nur dx I was using

Risk for infection r/t abcess and fistula formation (AEB perianal abcess & colovesical fistual)

Diarrhea r/t inflammed bowel (AEB 3 loose liquid stools in a 3 hour period, ABD pain, hyperactive bowel sounds)

Imblalanced nutrition less than body requirements r/t failure in ingest food adequate for formation of RBC (AEB low serum albumin, low RBC count, low hct and hgb) Is that right???

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Specializes in med/surg, telemetry, IV therapy, mgmt.

i re-sequenced the diagnoses in proper priority order:

diarrhea r/t inflamed bowel aeb 3 loose liquid stools in a 3 hour period, abd pain, hyperactive bowel sounds.

imbalanced nutrition: less than body requirements r/t failure to ingest food aeb low serum albumin, low hct and hgb, and adequate formation of rbc (low rbc count).
are you sure this isn't dehydration and not deficient fluid volume?

risk for infection r/t abcess and fistula formation aeb perianal abcess & colovesical fistula
a "risk for" diagnosis means the problem has not occurred yet and is anticipated to occur. an abscess is a "localized collection of pus in any body part that results from invasion of a pyogenic (pus-forming) bacterium." [page 8,
taber's cyclopedic medical dictionary
, 18th edition, published in 1997 by f.a. davis company]. since this patient's
medical diagnosis
is a perianal abcess, then we already know he
has
an infection. what other infection could he be at risk for?

the r/t, or cause, of the risk is what is causing the infection. an abscess and fistula are the result of the infectious process that has continued without medical intervention. so, even if this were a valid diagnosis, the r/t part would be wrong.

there is never any aeb items accompanying with these diagnostic statements. why? the problem doesn't exist yet, so there can be no evidence of it. (aeb means "as
evidenced
by")

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in deficient fluid volume wouldn't the RBC, Hgb, Hct be elevated? I thought albumin was a big indicator of inadequate nutirion. This pt is also on TPN recieving dextrose 25% amino acids and fat emulsion 20% 500 mL q24h. Pt is also recieving vitamin C supplement and Zinc supplement. We held the potassium on this cinical day because the value was in normal range and there is potassium infusing through the TPN. Pt is on antibiotics but WBC count is with in the normal range.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

in deficient fluid volume wouldn't the rbc, hgb, hct be elevated

rbcs, and the h&h are also low when there has been loss of blood. blood is a fluid. you didn't mention in your first post that this patient was on tpn. you just listed your diagnoses and gave no other information.

i thought albumin was a big indicator of inadequate nutrition.

albumin and protein are lost with renal failure.

this pt is also on tpn receiving dextrose 25% amino acids and fat emulsion 20% 500 ml q24h. pt is also receiving vitamin c supplement and zinc supplement. we held the potassium on this clinical day because the value was in normal range and there is potassium infusing through the tpn. pt is on antibiotics but wbc count is with in the normal range.

didn't know that. that changes a few things in my thinking.

risk for infection r/t concentrated glucose solution infusion and presence of invasive iv line
- the infection risk here is for
sepsis

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thank you for responding so quickly :) pt also had an I & D of the fistula. The tpn can also cause diarrhea and gas right?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

i don't think so. these are the links for tpn from the any good iv therapy or nursing procedure web sites sticky on the nursing student assistance forum.

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Thank you for all the information. I was actually have a hard time finding information on my school database about TPN.

Can I still use my original nur dxs? Pt is at risk for sepsis but that isn't a nursing diagnoses in any of my books. That is why I put risk for infection.

Thank you so much you have been so helpful

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Specializes in med/surg, telemetry, IV therapy, mgmt.

sepsis is a medical diagnosis. the diagnosis you use is risk for infection r/t concentrated glucose solution infusion and presence of invasive iv line. i was just saying that the infection the patient would be at risk for is sepsis. when you write your nursing interventions you will be monitoring for signs of sepsis (fever, chills, restlessness, confusion, diaphoresis, anorexia, vomiting, diarrhea, pallor, hypotension, tachycardia, and oliguria) caused by high blood sugars or an infected central line. so, your interventions will include doing blood sugar monitoring and central line entry site inspections, and vital sign measurements. see this post for guidelines on writing interventions for "risk for" diagnoses: https://allnurses.com/forums/2751313-post8.html

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Hello, I have a client with the same diagnosis. He is having Diarrhea too and said that he does not want to take his collace because of the Diarrhea. On a care plan with Diarrhea being the problem, what would a goal and 3 interventions that I could take to assist?

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Specializes in pediatrics, occupational health.

i actually had a pt. like this in my first round of clinicals. (fistula, diarrhea - but had colostomy). My RN withheld colace. She said that was part of the critical thinking that nurses had to use - as well as monitoring all the lab results and figuring out the why's for the abnormal results - among everything else!!!

just one of the many lessons I learned.

I would think that goal #1 would be "Client will have a soft formed stool" q day or q every other day.???

Have you been to this website: http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/

you can find all the stuff you need from there. It goes with my book, I don't know which one you use, but this is just like my bible!!! ha!

good luck!

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