paraplegic pt. diagnoses help

[Deezywheezy]

I have a pt. that I have to write a careplan on who is a paraplegic and I'm not really sure about what diagnoses to pick. This pt. came in because they had bilateral DVTs and when they were admitted they found out this pt had a UTI. The pt. was using a foley catheter at home and was on a foley in the hospital as well but that was d/c and a straight cath will be used instead.

The two priority diagnoses that I was thinking of was ineffective peripheral tissue perfusion and impaired urinary elimination but like I said above i'm not really sure if these are the best ones to pick. Are there any better ones? or are these good?

Any help will be greatly appreciated! Thank you!

[nurseprnRN, BSN, RN]

a dvt will not cause a stroke, although many people who have forgotten normal circulation anatomy think it will. follow the blood flow from leg to brain-- how would a clot get to the brain from there? is there another risk from dvt that would be more likely?

(an arterial thrombus, e.g., in a carotid artery or an intracardiac thrombus in the left heart, could cause a stroke, though.)

in terms of necrosis in peripheral tissues, is anybody here remembering that this is a paraplegic? hint, hint, hint.

if i don't see the actual answer by the end of tomorrow i will just have to tell you, i guess, but risk of this complication is so basic to paraplegia care that i'm astonished nobody has it by now. while accelerated cardiovascular disease will make it more likely, it's a huge risk in any para, young or old, recent or remote.

[snow_bear]

Pulmonary embolism

Pneumonia

Pressure sores/ulcers

????

(edited for spelling)

[nurseprnRN, BSN, RN]

ding-ding-ding!

ding-ding-ding!

ding-ding-ding!

:yeah:

all three are causes of mortality and morbidity in sci! (and you can add sepsis from urinary tract infections and from pressure ulcers, two more)

(of course, none of these except pe have anything to do with the dvt, but are all so important with sci.)

[xtxrn, ASN, RN]

a dvt will not cause a stroke, although many people who have forgotten normal circulation anatomy think it will. follow the blood flow from leg to brain-- how would a clot get to the brain from there? is there another risk from dvt that would be more likely?

(an arterial thrombus, e.g., in a carotid artery or an intracardiac thrombus in the left heart, could cause a stroke, though.)

in terms of necrosis in peripheral tissues, is anybody here remembering that this is a paraplegic? hint, hint, hint.

if i don't see the actual answer by the end of tomorrow i will just have to tell you, i guess, but risk of this complication is so basic to paraplegia care that i'm astonished nobody has it by now. while accelerated cardiovascular disease will make it more likely, it's a huge risk in any para, young or old, recent or remote.

respectfully disagree re: dvts not being able to cause a stroke. not common, but possible. :)

definitely agree with the pes, pressure ulcers, and pneumonia being big risks d/t immobility w/para.

i'm not able to get to my physiology book (and it's even one from this decade ).... had to settle w/this.....for quick answer

http://www.webmd.com/dvt/deep-vein-thrombosis-complications

[nurseprnRN, BSN, RN]

body > [color=#2b4cdf]veins > vena cava > right atrium > tricuspid valve[color=#2b4cdf] > right ventricle > pulmonic valve[color=#2b4cdf] > pulmonary artery > lungs >pulmonary vein > left atrium > mitral valve > left ventricle > aortic valve > arteries > body

follow the above path. the only way a venous dvt can get to the cerebral arterial circulation is if there is a direct connection between the venous side and the arterial side in the heart and the venous pressure is higher than the arterial pressure.

anyone with an atrial or ventricular septal defect and a right-to-left shunt could be at risk for arterial embolus of venous origin, and this would be bad. however, since in most people, the left heart pressures are significantly higher than right heart pressures (by a factor of five to ten, more or less), any air or clot in the right heart keeps going right on out the pulmonary artery to the capillary bed. that strainer function is one reason you have a pulmonary capillary bed.

unsuspected asds are a known cause of stroke in younger people who lack other risk factors-- think of the much-beloved erstwhile heart and soul of the patriots' line, tedy bruschi, whose stroke fortunately resolved and whose asd was repaired endoscopically; he went back to football for the rest of that season and the next four (although he has since retired). as a matter of fact, most asds are found by accident or on post for unrelated issues, since the left-to-right shunt doesn't do much harm unless it's so huge that you get bad pulmonary hypertension and capillary bed damage (seen in single ventricle, for example).

[xtxrn, ASN, RN]

Never heard of Tedy Bruschi I have heard of the risk of a CVA from a DVT for ages- never heard it was all that common- but that it wasn't impossible :) If the DVT in this patient blows, PE is the biggest risk, so I'm game to let it rest there. (however, I WILL get out my pathophys book when I can maneuver the stuff around it-LOL... I'm always looking to "relearn" a lot; I worked mostly neuro - and most of those CVAs were ICH, or atherosclerotic... also a lot of AVMs causing trouble. I've been up for 30 hours, so vocabulary isn't great right now )...... In the interest of the OP, I'm signing out- (*&^ not being able to reach that book

I'm way past needing to come up with something for a care plan - and am probably too tired to attempt to think right now- but stasis ulcers would be an issue for someone not moving. My brain is mush.... :zzzzz