Nursing Diagnosis and Care Plan Question

[Smarty Pants]

My patient came to the hospital for Acute Renal Failure,dehydration plus she refused to eat and drink. She is an 86 year old lady that is going to be taken care of per hospice as of now. She is barely responsive and has been taken off all meds per Doctor, no Iv's no blood draws- nothing. My quesion is, that I need to find a Nursing Diagnosis that would have to do with end oflife care, and my interventions of course would have to do with keeping her comfortable, ect.... I'm having a difficult time finding a fitting Diagnosis. Any suggestions would be SO VERY HELPFUL! Thanks!:heartbeat

[BabyLady, BSN, RN]

Fluid volume deficit....this is what will lead to her death. However, this isn't going to be fixed if she is in renal failure.

Ammonia levels...are going to be sky high in the patient whose kidney's are not going to work...so her brain function will be impaired.

Whenever you have multiple nursing Dx to choose from...find the one that you need to fix first, or the one that is the most life threatening.

[Daytonite, BSN, RN]

diagnosing is about determining what the patient's nursing problems are first. not what they need. their needs are developed as a result of the problems they have. to diagnose you must first assess the patient. assessment consists of:

• a health history (review of systems)
  
• performing a physical exam
  
• assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
  
• reviewing the pathophysiology, signs and symptoms and complications of their medical
  
• reviewing the signs, symptoms and side effects of the medications they are taking
  

that is the first step of the nursing process. after collecting all of that data you are looking for what is abnormal to fall out. it is abnormal data that gives us the evidence to support any nursing diagnoses. you need that evidence to know what is going on with the patient.

these two websites from hospice organizations will give you some ideas of the kinds of nursing problems and issues that dying patients face.

• http://www.mywhatever.com/cifwriter/library/eperc/fastfact/ff_index.html - index of subjects
  
• http://www.stvincent.org/ourservices/hospice/preparing/default.htm - see links at the left side of the page
  

three things caught my attention about this patient:

• she is dehydrated - what were signs and symptoms you observed of this?
  
• refused to eat and drink
  
• is barely responsive - what were specific symptoms you can describe of this?
  

that is abnormal data i was talking about collecting. this data can be used to form nursing diagnoses. think of what the major adls are (bathing, dressing, mobility, eating, toileting, and grooming) because there are 4 nursing diagnoses that cover them. how are they going to be accomplished for her? as nurses, one of our major functions is to help people accomplish their adls. here is a extreme case at one end of the bar where the patient probably can't do any of her own adls. now, nurse, how will they get done?