Outcomes help!!!

[2bCaligirlRN]

My diagnosis is

Fluid Volume Excess

R/t chronic renal failure

AEB edema, decreased Hb and Hct, pulmonary congestion, and pleural effusion.

I am looking in my Doenges book and saw the outcomes listed, however they both involved the patient "verbalizing" or "demonstrating". My patient can't speak and is total self-care deficit. I need three outcomes and this is what I have so far

• Patient will stabilize fluid volume as evidenced by balanced I/O and vital signs within client's normal limits throughout the shift.
  
• Patient's lower extremity circumference will diminish daily
  

Are these okay? Can anyone help with the third? Thanks

[mybrowneyedgirl, BSN, RN]

What about a measurable loss of weight? That could be an indicator of decrease in fluid retention. An increase in Hb and Hct...

I am far from an expert. Good luck.

[Daytonite, BSN, RN]

you've got some problems with your nursing diagnostic statement: fluid volume excess r/t chronic renal failure aeb edema, decreased hb and hct, pulmonary congestion, and pleural effusion.

problem

: fluid volume excess

etiology

: chronic renal failure - you cannot use a medical diagnosis as an etiology, or cause, of a nursing problem - you can say there is "renal dysfunction"

symptoms

: edema, decreased hb and hct, pulmonary congestion, and pleural effusion

outcomes and goals are what you predict will happen when your nursing interventions for the edema, decreased hb and hct, pulmonary congestion, and pleural effusion are executed. there are 4 types of nursing interventions:

• assess/monitor/evaluate/observe (to evaluate the patient's condition)
  
• care/perform/provide/assist (performing actual patient care)
  
• teach/educate/instruct/supervise (educating patient or caregiver)
  
• manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
  

since you haven't divulged any of your interventions, it is near impossible for me to suggest any outcomes for you. i don't understand why you have an outcome of "patient will stabilize fluid volume as evidenced by balanced i/o and vital signs within client's normal limits throughout the shift". chronic renal failure patients never have a balanced i&o. they retain fluid which is drained off at their dialysis treatments 3 times a week. daily weights are a better measure of their fluid status. crf patients often have some degree of pitting edema that never goes away. people with chronic renal failure have anasarca, a type of edema that involves all the tissues of the body and not just the lower extremities. calf measurements are probably not a very effective assessment tool either. with pulmonary congestion and pleural effusion wouldn't you be assessing the patient's breath sounds and respirations? how are you going to know when the pleural effusion has gotten better or worse so you can write an outcome for that? wouldn't this patient be coughing or having problems breathing with all this pulmonary congestion? what kind of interventions will you order? as the patient's fluid status improves how will you know the lung situation is better? wouldn't you want an outcome addressing respiratory status since it is one of your points of evidence proving fluid excess? what nursing interventions treat the low hbg and hct? how will you know the hbg and hct have improved? if you read up on crf you will find that anemia goes along with the renal failure because as the kidneys fail they also stop producing erthropoietin, the substance which stimulates the bone marrow to produce blood cells.

• http://www.kidneyschool.org/splash/toc.shtml -- kidney school
  
• http://www.renalinfo.com/us/ -- what is kidney failure?