Nursing care plan question

[aperry245]

I have a care plan question. I'm still in fundamentals and this is my first care plan for clinical (we've had to do some for fake scenarios to practice). Our instructor has already said multiple times that she wants us to keep it basic (but right, obviously), so I'm not looking for super in depth info, but just a couple of questions.

Ok, so my diagnosis is deficient fluid volume r/t blood loss AEB tachycardia, dry mucous membranes and weak pulse pressure. My patient had DIC and was also vomiting and had been prescribed Zofran. So, my etiology is definitely the blood loss from the DIC (they had not yet ordered blood while I was there, but I know it was in the works), but the vomiting was also a problem for further fluid loss. Most of my interventions relate to replenishing fluids, assessing vitals, teaching about symptoms, etc but I currently have two interventions related to the nausea/vomiting and I'm not sure if I'll get docked for it not directly relating? In my mind it does because obviously vomiting is going to make the patient's condition worse (which my short-term goal without details is basically that the patient doesn't get worse), but since the etiology is blood loss and not vomiting, does it directly relate in my care plan, or would that be a separate nursing diagnosis (nausea) and I need to find something more directly related to the blood loss/DIC? Alternately, could I include vomiting in my etiology? related to blood loss and vomiting as evidenced by___” etc?

Again, I feel like it goes” because it matches my goals of the patient's condition remaining stable in the short term and resolving in the long term and obviously keeping the patient from vomiting is going to help that.

Thanks!

[Kuriin, BSN, RN]

I don't know why you think you're doing anything wrong. ;-) Vomiting leads loss and dehydration, furthering the hypovolemia. But, it also leads to electrolyte imbalance. Go with what you got, man.

[Lev, MSN, RN, NP]

I think you can add the vomiting to the etiology but definitely address the bleeding in your interventions because that is your primary problem.

[aperry245]

The blood loss was past, not current. The patient was no longer actively bleeding (though certainly still at risk). I was trying to find something to address/assess blood loss specifically, but I couldn't find a rationale w/intervention in our material because we're focusing more on basic stuff and not the disease process yet. I realize I might be overthinking this.