nursing diognosis help!!!

[2bnurseshanley]

70 yr old male c/o right sided abd. pain vomiting diarrhea.admit. to ER dx. test and colonscopy found malignant mass laproscopic colectomy done. mas was encapsulated but aggressive, chemo planned

past medical hx ~ iddm and htn

current medsnovolin nph, red insulin on sliding scale, atovolol

i need 10 nursing diagnosis and 1 teaching plan

can anyone help?????!!!!!

[VICEDRN, BSN, RN]

1)potential for impaired nutrition less than optimal....rt being post op and losing part of his digestive tract

2)potential for dehydration rt post op and age and loss of part of his digestive tract

3)pain rt post op

4)impaired mobility rt post op and possibly, age

5)self care deficit

6)knoweldge deficit rt to op procedure and results

...if there is indeed a colostomy involved....

7)alteration in body image

8) grieving for loss of former self

and perhaps when you get to actually meet him you will find others.....some things i could suggest may have no bearing for this patient, if he is long term HTN and IDDM and these have to be careplanned, but, i would think they would tend to be at the bottom of the list.....keep in mind that the elderly often dont tolerate surgery particularly well....

looks like we think the same in some ways....lol:bow:

[VICEDRN, BSN, RN]

don't forget psychosocial

anxiety

fear

and

risk for impaired skin integrity due to ostomy.

Please tell me we are not doing your homework for you? It won't help any if we do it for you.

[2bnurseshanley]

no your not doing my homework that would make me a bad nurse and i would never learn anything from it. i just wanted to make as many things as i could for my client and once again thanks to all the help everyone !!!!:wink2:

[RedhairedNurse, BSN, RN]

NurseShanley,

I saw that post about someone "not wanting to do homework for you." That sounded a little harsh to me. It sounds as though you are trying and I personally don't mind helping people that help themselves. Sorry you experienced that, esp since being a new user.

You appear to be on the right track. I use to always look in the back of Taber's. That was always very helpful to search all diagnoses to see if they applied to my patient. I had help in nursing school, I paid my dues too, but I'm thankful to those who offered their assistant.

Some that come to my mind:

-Risk for falls r/t his age/weakness

-Electrolyte imbalance r/t diarrhea

-Hypertenstion

-Glucose Metabolism impaired, teach about hypoglycemia

-Impaired Skin intergrity r/t colostomy

-Risk for infection r/t chemo agents lowering WBC count, possibly

causing neutropenia as well.

-Fear r/t the unknown

-betablocker - be sure to check HR and BP before administering a beta blocker, also make sure pt hasn't any history of asmtha or anything like that because beta blockers can aggravate that.

Teaching can be done on colostomy, proper control of diabetes. This is where you need to decide what is the priority as far as teaching goes.

[2bnurseshanley]

thanks RedhairedNurse i really appreciate that

well so far i have these and i hope the like the best ones to use

self care deficit rt pain & impaired mobility AEB pt stating " im in to much pain to get up"

risk for impaired skin integrity rt poor nutrition age and hx of iddm

acute pain rt surgery AEB pts facial expressions

ineffective coping rt diag of serious illness(cancer) AEB pt saying " this is all just to much for me to handle"

risk for infection rt invasive procedure ( lap colectomy)

imbalanced nutrition less then body requirements rt inability to absorb nutrients ( lap colectomy)

impaired physical mobility rt medical restrictions ( surgery also age) AEB restrictions of movements

fluid deficient volume rt acute fliud loss (diarrhea, vomiting and post op) AEB decrease in skin turgor

i need 2 more and im doing my teaching plan on chemo and what to expect since thats a very hard thing to go thru and im sure if i was my pt i would have 10000000 questions about it

thanks everyone for all your help

[MO3BB]

you should look in your med/surg textbook under each diagnosis/surgery. They always have a boatload of care plans. After all, that's what nursing school was full of--care plans, care plans, and more care plans!

[RedhairedNurse, BSN, RN]

Sounds like you're doing a good job, but I'm not an instructor. We always think we're a step of head of those instructors, but yet they always seem to find something lacking. good luck.