PLEASE help with Jaundice Care plan!!!!

[New 2 iceeYouRN]

Hello All!

I've been working all day on my care plan for my patient with obstructive jaundice and I had no idea it would be this difficult!! My patient is a 65 y/o F who presents to her PMD with complaints of a yellow tinge to her eyes. He admits her to the hospital for further eval. She has an ERCP, EGD, and sphincterotomy preformed. No gall stones noted but there was a mention of biliary stricture. They wanted to preform an MRCP but the patient refused d/t claustrophobia. There was no CT preformed. I have come up with my key problems of:

1. Jaundice

2. Constipation

3. Pain

My constipation and Pain are not difficult to work up interventions for, however her jaundice is most problematic. Her supporting data for all that is the ERCP findings, and all of her LFT including Bili T, C, U, alk phos, AST and ALT. However I have no idea what kind of interventions to preform on her besides assessing for improvements of her bili and ast and alt. Lastly, her NANDA for jaundice! I was leaning towards Impaired Liver function which I found as a new NANDA on this list http://wps.prenhall.com/wps/media/objects/3918/4012970/NursingTools/koz74686_AppC.pdf

However I'm unsure if this is even correct. Perhaps a nanda of Risk for imbalanced nutrition less than body requirements due to impaired absorption.. but does impaired absorption occur with obstructive jaundice??

PLEASE HELP!!! All comments are welcome

THANK YOU!!!!

[Daytonite, BSN, RN]

you have defined the patient's nursing problem. a care plan is about identifying the patient's nursing problems and then developing strategies for them. what you are doing is trying to treat the medical problem and as nurses we can't do that. the doctor's don't even know what her medical problem is, so how can we figure it out? i was following you as far as your identification of the patient's 3 nursing problems (jaundice, constipation and pain) and after that things got muddled and i lost track of your thinking. a care plan is based on the patient's assessment symptoms. while you didn't include the symptoms of the constipation and pain, you did include them for the jaundice:

• yellow tinge to her eyes
  
• elevated lab values
  

while you didn't include any evidence of pruritis or the patient's thoughts on her yellow appearance i immediately thought of two possibilities for this:

• risk for impaired skin integrity r/t itching
  
• risk for disturbed body image r/t jaundiced skin
  

- - - - - - - - - - - - - -

i was leaning towards impaired liver function which i found as a new nanda on this list http://wps.prenhall.com/wps/media/objects/3918/4012970/nursingtools/koz74686_appc.pdf

however i'm unsure if this is even correct.

the actual diagnosis is

risk for impaired liver function

. without the taxonomy information to guide you in its use, i wouldn't assign any nursing diagnosis to a patient.

perhaps risk for imbalanced nutrition less than body requirements due to impaired absorption. but does impaired absorption occur with obstructive jaundice??

your interventions for a "risk for" diagnosis have to be to

prevent that problem from happening

and i think you are crossing into the doctor's realm of practice if you are talking about obstructive jaundice as the risk factor here.