Please help-collaborative problems and potential complications

[DolceVita, ADN, BSN, RN]

Ugh! I seem to be getting all in a twist about this:

I have a female, 85 yrs, with advanced dementia, AFib, HTN, hypothyroidism, hx osteomylitis (with resultant AKA). Entered facility under protective order of social services 18 months ago. She has limited ability to communicate (instructor thinks an expressive aphasia etiology unknown possibly from dementia progression or previous CVA -- chart is incomplete)-- can generally answer/indicate yes or no to direct, simply put questions ("are you hungry?", "do you have any pain?"). Complete assist for everything except that she can bring food to her own mouth with very little difficulty.

I have much more assessment data but that is the bare bones.

I need to identify collaborative problems and potential complications for her medical diagnoses. This is where I get a bit confused. Let's say I take the AFib as my medical diagnosis -- would a collaborative problem be decreased cardiac output and then my potential complications be ineffective tissue perfusion r/t decreased CO? Or is ineffective tissue perfusion another potential complication and the collaborative problem is altered electrical conduction?

I am a little confused and my thinking is going around in circles. I don't want anyone to actually do my work for me but if you can help me get my thinking straight on this AFib example I should be able to noodle out the others.

If you can help I could use some steering.

[Daytonite, BSN, RN]

your confusion here is that (word for word) i need to identify collaborative problems and potential complications for her medical diagnoses. decreased cardiac output and ineffective tissue perfusion (which is the same as decreased cardiac output, by the way, are nursing diagnoses. when you are talking about medical diseases and conditions in terms of the doctors treating them, they are also concerned about the problems and complications of the disease and medical care. you know how i am always harping about "follow the nursing process" when writing a care plan and picking your patient's nursing diagnoses, which are really their nursing problems? well, doctors do the exact same thing when they diagnose. they come up with a list of signs and symptoms that lead them to identify the disease or condition (the problem). they order treatment, sometimes aimed at the cause of the disease, but very often at the individual symptoms and any complications of the disease or the treatments. and who does these treatments? nurses and other licensed and unlicensed personnel who sometimes also have some interventions they can also apply--those would be the collaborative problems, or symptoms of that disease. potential complications, of course, are just that. the potential complications of atrial fib are: tia, stroke, heart failure and thromboembolism (page 98, nurse's 5-minute clinical consult: diseases).

the family practice notebook (use search box and input a disease) http://www.fpnotebook.com/index.htm will give you the treatment from the doctor's perspective and includes signs and symptoms, how a disease is diagnosed and any complications.

a collaborative problem might be the patient having some dizziness along with the af as tends to happen when an arrhythmia is present. you both have responsibilities for addressing this. dizziness is a symptom of af so maybe the drug regimen isn't effective and the doc needs to re-assess his treatment plan. you need to monitor and manage the treatment and notify the doc of any unusual or abnormal tests or side effects of the meds that might be a cause of the dizziness. you are also both responsible for her safety and in the real world some safety measures require a doctor's order to initiate.

now, knowing that the formation of blood clots is a big complication of af if you had to turn that into a nursing diagnosis we, as nurses are talking about a potential nursing problem of a thromboembolism. check your patient data. is she on coumadin? is she on any beta blockers or antiarrhythmics to correct the af? then, the doc is treating it and one of your collaborative nursing interventions for decreased cardiac output r/t altered electical conduction will be to administer medications as ordered while one of your independent nursing interventions will be to plan regular rest periods for the patient. or risk for injury could be used if you want to go for the possibility of an mi or a stroke.

does that help? carpenito's care plan books usually listed collaborative problems in them for the various diagnoses. because i moved recently, have been on chemo and just got home from 5 days in the hospital, most of my books are still packed i can't find my copy of one of her books at the moment.

[DolceVita, ADN, BSN, RN]

It does help. Thanks.

Also, I think I will try to sit down with my instructor to ensure that she and I are using the same definitions. One of the things that confuses me is I consider syncope (as one example) a sign of a complication rather than a complication in itself. My instructor says not. Of course, syncope has its own potential complications.

Oh and thanks for the fpnotebook link.

[Daytonite, BSN, RN]

i posted a whole bunch of helpful websites on this thread a long time ago. it was made into a sticky. bookmark it:

• https://allnurses.com/nursing-student-assistance/medical-disease-information-258109.html - medical disease information/treatment/procedures/test reference websites