Please help, instructor wants diagnosis not related to Fundamentals

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Hello, I'm new here to the site and I think I posted my question in the wrong place. I have a patient who has Celulitis, hx of renal insufficiency, type 2 diabetes, obesity, hypertension, and CHF. I want to use skin integrity but my instructor wants us to get past fundamentals. We can't use mobility related, fall risk, all the ones you start out with. I'm really stuck. My patient was in extreme pain so I am going to use Acute pain, she was diagnosed the last day I was there with superficial thrombophlebitis. I thought tissue perfusion would relate as she has peripheral circulation issues, low hgb, hct, rbc. Any advise for diagnosis would be extremely appreciated! I only have 6 more weeks and I am so scared of not making it :confused:

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How about activity intolerance? If her hct, hgb, rbc are low that's indicative of Anemia, thus feeling fatigue, etc and not being able to do the daily activities.

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Thank you, I was thinking the same thing but wasn't sure, I'm not feeling so sure of myself these days. Her hx says nothing of anemia nor anything else but her labs sure do! Thanks again

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Specializes in Med/Surg, L&D.

Activity intolerance can also be related to her CHF. What about fluid volume excess related to CHF and chronic renal insufficiency? You would need some more data to back that up (edema, crackles in the lungs, etc.). How does your instructor feel about risk for diagnoses? You could also get to some psych social issues, if any exist, to get beyond the basics.

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Specializes in Nursing Education.

I like your idea of Ineffective Tissue Perfusion, too. If the cellulitis has a lot of edema involved with it, plus being diabetic she probably has peripheral circulation problems.

Impaired Gas exchange could also be used if she has fluid backing up into her lungs related to (left-sided) CHF.

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