i was in the icu during clinicals over the weekend and had a gentleman with renal failure, dm ii, dehydration, hyperkalemia (in the 7's!!!). when i came in on sunday, he looked awful. bp was 72/40, pallor, etc. i called the doc and he ordered a stat troponin. it came back as 5.45 (the day before it was
many of my nursing interventions revolved around keeping him calm and as pain free as possible. we couldn't push morphine or give nitro d/t his bp being so low.
the careplans i had completed went completely out the window because they were no longer applicable because of his deteriorating state. i am re-writing them and have the following:
priority #1: decreased cardiac output due to altered contractility; hyperkalemia associated with cardiomegaly, renal failure and acute mi.
priority #2: imbalanced fluid and electrolytes due to hyperkalemia and hypocalcemia associated with chronic renal failure.
priority #3: fear and anxiety due to symptoms being experienced with mi and being transferred to an unfamiliar environment associated with mi.
do you feel that these are in the correct order? i did every single intervention i could do increase his cardiac output and try to correct his imbalanced fluid and electrolytes. but, i barely left his side other than to get meds and items to improve comfort. we are not permitted to use acute pain as a nursing diagnosis (it's the rule at my college because they feel we should be concentrating on more "difficult" diagnoses).
if anyone would mind looking them over and provide feedback, please let me know (hint, hint daytonite).
