Nursing Diag. help PLEASE!

[BrujahAngel]

thanks in advance for any and all help! i am trying to come up with a second nursing diagnosis for my patient tomorrow, and i am continually running into walls! she was admin for uti, pyelonephritis. hx of disseminated intravascular coagulation, acute renal fail, septic shock, she has 3 stage 3 or greater pressure ulcers, peg tube. wbcs are extremely high 20.4k.

i've already got impaired skin integrity r/t pressure aeb altered skin layers and tissues.

:eek:i'm lost on a second approved diag.

thanks again for any direction!!!!

[EricJRN, MSN, RN]

One common issue is that people try to take a list of medical diagnoses and turn it into a list of nursing diagnoses. That will limit your options. Think about the nursing process. What physical assessment data do you have?

[BrujahAngel]

I haven't seen my pt yet, all I have are lab values, her three pressure ulcers, and her diagnosises.

[EricJRN, MSN, RN]

Blah. No fun. Doable though. Why does she have a PEG? Was she in septic shock on this admission? What other results do you have?

[DixieRedHead, ASN, RN]

What do her other labs look like? Electrolytes? Think WHY.

[BrujahAngel]

it's hard for me to ready most of her chart because they still have paper charts and i think i could read chicken scratch better than most of the handwritting in there!! from what i understand from her chart the septic shock is r/t the uti...her abnormal labs:

rbc 3.38

wbc 20.4

h/h 10.6/30.2

rdw 16.9

neutrophils #18.5

neutrophils %90.6

lymphocytes %3.8

monocytes %3.8

bands17

chloride 109

bun43

bun:creatine72

glucose 63

calcium 8

[nurseprnRN, BSN, RN]

"uti, pyelonephritis. hx of disseminated intravascular coagulation, acute renal fail, septic shock, she has 3 stage 3 or greater pressure ulcers, peg tube. wbcs are extremely high 20.4k."

if you read up on all those diagnoses, i would be astonished if you couldn't imagine some things that a nurse would have to look at.

for example, what is dic? what does it do to the body? what would you assess to look for its effects? what kind of damage might occur from it? how would you know? what would a nurse do to treat those effects, prevent complications, and help the patient get through the day?

she has pyelonephritis, a medical diagnosis, and acute renal failure, another. what do those mean? what kind of symptoms would you see if you examined her in the bed? what do those do to the body? what would you assess to look for their effects? what kind of damage might occur from them? how would you know? what would a nurse do to treat those effects, prevent complications, and help the patient get through the day?

she has three stage 3 pressure ulcers? surely you can think of more than "altered skin integrity" related to nursing assessment and treatment and prevention there. read up on pressure ulcers and find three common causes for them and associated conditions, then look to see what nursing can do about each of them, and why.

and...don't put off this sort of assignment til midnight of the day before it's due.... you have way too much to look up and learn before you care for this poor lady to short-change her. this may be the first chance you have to learn that lesson, but i can promise you it will not be the last. there's a lot more to nursing and being a nurse than people think sometimes.

[BrujahAngel]

and...don't put off this sort of assignment til midnight of the day before it's due.... you have way too much to look up and learn before you care for this poor lady to short-change her. this may be the first chance you have to learn that lesson, but i can promise you it will not be the last. there's a lot more to nursing and being a nurse than people think sometimes.

the reason it was midnight the day before my clinical is because i ddn't recieve my patnt until thusday afternoo, friday ws class until 4, drive home, for 45 mins, then studin up on the different drugs an medcal diagnosis. each drug the pt is on we have to fill outa worksheet that takes about 10 mins ec..times that by 20 drg...i am inn way trying to wait to the last min. to do an assinment...said assignment just takes time to do.

as far as reading aout the diagnises, i hve a hard time seeing the nursing diagnses associated with them before i see my pt...if that makes since?! :) seeing something in black and white is not th same as seeing it in person.

anway, thank you both for your help in this. ths is my first semester actually caing for pts, and my first time in the icu...it was a challege, but i learned a lot!! :redbeathe