Nursing care plan help

[Leonardsmom,LPN]

Happy Easter all, working on my care plan for pt that had and was hoping for some input. My pt was a 71yr old male with PAD admitted for diabetic wet gangrene of the foot with amputation of the toes on the affected foot. Lab values indicate anemia with RBC upon admission at 2.60 and 10 days later 2.57, Hgb 7.1 adm. latest 2.57. Electrolytes upon adm WNL, latest Sodium and Potassium low 131 and 3.2 respectively. Total protein upon adm was 6.5 latest 5.9, Albumin on adm 3.5 latest 3.2 (hosp range 3.6-5.0). BUN adm 12 latest 25 (hosp range 6.23) and CO2 total (hosp range 20.0-30.0) 21.0 adm and 19 latest. Pt experiencing anorexia eating 25% or less of meals, increasing confusion at times alert and oriented to person only other times A&Ox3, has become incontinent of bladder and bowel, lethargic sleeping most of the time, and has experienced a weight loss of about 20% in the last month, since the time admitted to the floor weight loss of 9% in one week.

Pt is receiving Megace to help with the anorexia and to increase appetite, and Ferrous sulfate for the tx of anemia. The three priority health care problems (nursing diagnoses) I felt that was going on with this pt are

1. Adult failure to thrive r/t depression AEB anorexia, apathy, cognitive decline, consumption of minimal food at meals, inadequate intake of food, physical decline incontinence of bowel and bladder, and unintentional weight loss 9% in 7 days.

2. Impaired tissue integrity r/t PAD, altered circulation and nutritional deficit AEB ulceration of R. foot

3. Imbalanced nutrition less than body requirements r/t inability to ingest food, inadequate protein intake AEB lack of interest in food, decreased food intake less than 25% of meals eaten.

My main diagnoses that I am focusing on and writing my care plan on is adult failure to thrive. I have to come up with a outcome for my patient that is (SMART). Out of the things going on with him nutrition I feel is one of the biggest things (although there are several other factors that also need to be addressed at the same time I think, but we have to address only one problem). With my thought upon my goal for this pt would be that Pt. will consume at least 2000 calories per day via meals, protein supplements and snacks, maintaining current weight of 145 lbs.

I also need to have 4 interventions

1. Perform a geriatric depression screen to assess for possible depression which may effect the desire to eat.

2. Assess pt for any specific meals or snacks may desire which family could bring in which they would be interested in eating.

3.Provide snacks and protein supplements between meals to encourage increase of caloric intake.

4. Provide soft foods that are easy to chew and swallow.

Overall think I am on the right track with this, but would definitely would appreciate any feedback.

[nursej22, MSN, RN]

Your last 3 interventions are focused on nutrition, which is your second problem. Are there any other interventions specifically for the depression? Improving the environment, activity, pet therapy or visits from family, volunteers? Music?

[Summer Days]

Unless I am getting it wrong, your priority nursing diagnoses should be in the areas of electrolyte imbalances, tissue perfusion, & infection. So of course pull your nursing diagnosis book and check for nandas in those areas. Electrolyte imbalance can be supported by confusion and increased lethargy; tissue perfusion: did you perhaps assess B/P, HR, cap refill, skin temp and color?