Pancreatitis Nursing Diagnoses

[ICCU Nurse]

I'm trying to come up with Nursing Diagnoses for my pancreatitis patient. So far I have Acute pain r/t irritation of inflamed pancreas, Imbalanced Nutrition r/t NPO status, Impaired gas exchange related infiltrates/atelectasis of lower lung fields. In the progress notes the Dr. mentions the patient also had positive gram neg blood blood culture unknown organism and that the patient is on Flaggyl, Gentamycin and Zosyn but that's all I could find in the chart. I am brain dead right now and can't think of a nursing diagnosis to address the sepsis any suggestions would be appreciated. Also, do I assume the sepsis is related to the pancreatitis? If not, how do I figure out what has caused it? I've read everything in the chart and I still can't figure out what's caused it other than it's a gram neg organism. I know I should be using my critical thinking but I'm just not capable at the moment, please help!!

[Daytonite, BSN, RN]

Sepsis is a medical diagnosis. It doesn't much matter where this infection started. What are important are the patient's symptoms/responses to the sepsis. I had a septic infection and my biggest complaint was that I was cold and felt like I my insides were like an ice cube--all the time--even with a pile of blankets on me. Oh, and my white cell count was through the ceiling.

• Ineffective Thermoregulation R/T infectious process
  
• Impaired Comfort R/T increased metabolic rate

[ICCU Nurse]

Thank you Daytonite!!! I have such a hard time coming of with nursing diagnoses if I don't see them in my careplan book.

[FC_boi]

I'm trying to come up with Nursing Diagnoses for my pancreatitis patient. So far I have Acute pain r/t irritation of inflamed pancreas, Imbalanced Nutrition r/t NPO status, Impaired gas exchange related infiltrates/atelectasis of lower lung fields. In the progress notes the Dr. mentions the patient also had positive gram neg blood blood culture unknown organism and that the patient is on Flaggyl, Gentamycin and Zosyn but that's all I could find in the chart. I am brain dead right now and can't think of a nursing diagnosis to address the sepsis any suggestions would be appreciated. Also, do I assume the sepsis is related to the pancreatitis? If not, how do I figure out what has caused it? I've read everything in the chart and I still can't figure out what's caused it other than it's a gram neg organism. I know I should be using my critical thinking but I'm just not capable at the moment, please help!!

Prioritize your nursing diagnosis based on ABC or Maslow's heirachy of needs, from what you wrote you have impaired gas exchange i would write that down first above the other since airway is always the priority. However i dont understand is why would you make a nursing diagnosis out of the medical diagnosis. I know the fact that these medical diagnosis have their own set of signs and symptoms but arent you supposed to make a nursing diagnosis out of your physical assessment? Im not trying to be a jerk or anything im kinda confuse as well