Nursing Dx help?

Nursing Students Student Assist

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I'm having difficulty with a priority dx.

I have an elderly pt who was admitted for anemia/weakness/fatigue. Active blood loss, possibly GI. Awaiting tests since blood in stool was detected. Had 3U of blood and Hgb 24hrs later is 8.1; hct 23.1; rbc 2.560. As far as electrolytes go, calcium and chloride are the only abnormals.

Is this a tissue perfusion issue or fluid volume deficient?

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Specializes in Emergency.

Fluid volume deficit you would gather from assessment of sunken orbits, dry mucosa, urine less than 0.5ml/kg/hr etc. etc.

I'd be more inclined to go with the tissue perfusion myself. There are tons of things you could go with from tissue perfusion. Were you able to obtain cap refill? BP? HR? Ortho static hypotension?

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Assuming GI Bleed, I'd go Deficient Fluid Volume. My rational since Mike R is opposite of me, and I am in no way saying he's wrong, is I looked up GI Bleed in my Ackley book and DFV was listed, not Tissue Perfusion.

So I am only standing with my answer if it is a GI Bleed based on Ackley book. Mike R may have the better answer.

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Specializes in Emergency.

So I am only standing with my answer if it is a GI Bleed based on Ackley book. Mike R may have the better answer.

I'll give it to you. I didn't even open the book when I answered. I just peeked in Ackley and you're right. Assuming it is a GI bleed, I can't argue with that much can I?

I'm curious to know what the AEBs are though.

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I did not get to assess the pt. We get our pt info from the chart, diagnose then tell our diagnosis in pre-conf the next morning.

Only thing I really have to go by is the fact the pt was injured from a fall when standing, then anemia was discovered. Pt was also unable to get OOB w/o assistance. Constipation for 3 days that resulted in a tarry, black stool. As far as the heart goes, an EKG revealed NS rhythm w/occasional supraventricular premature complexes. Also has Afib. All vitals were within normal limits. There is slight edema in the lower extremities w/ chronic venostasis changes. This is really all I have to go on.

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Specializes in Emergency.

What were his HGB and HCT? If they were high, it'll help with the deficient fluid volume. If they were low I'd lean towards decreased tissue perfusion.

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hgb 8.1 and hct 23.1

That is really what has me leaning towards tissue perfusion. Thank you all for the help..unfortunately, I must go on to bed...but I do appreciate the input!

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Specializes in Critical Care.

While often related, a low H&H does not always mean deficient fluid volume, and might even be due to excessive fluid volume in the case of hemodilution. A low H&H would indicate a decreased oxygen carrying capacity which could cause decreased oxygen delivery to the cells; ie poor perfusion. With a low H&H, low volume should be considered by looking at the BUN to creatinine ratio, Blood pressure, CVP, edema, skin turgor, etc but isn't directly supported by a low H&H.

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A little more info:

Had 5 units of blood total. There is an unspecified bleed (tests pending). Slight edema in the feet, normal b/p, RR24, HR 96, BUN 29, Creatinine 0.9. Dark, tarry stools present as well.

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Impaired tissue perfusion...or whatever the wording of it is. I can't remember offhand.

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