Priority Problem for a patient Dx'd with Bacteremia

[TheNiceAshley]

This will be my 14th Care plan as an L2. My biggest struggle is wording a proper diagnosis for the patient. Once I have my High priority concept problem correctly labeled, everything else comes fairly easy, time consuming, but easy. So I'm just trying to figure out where to place the issue, concept wise, Safety or maybe Immunity?

Impaired Immunity isn't listed on the NANDA 2016 printout I have, as an actual diagnosis. I'm not real sure what Ineffective Protection is, sounds close? He doesn't have an open wound to make Impaired T/S Integrity useful. My Instructor frowns upon any diagnosis that starts with Risk of.. those ideas fall under the rationale for choosing the Priority problem. Soooo yea here's what I have concerning the patient, it's limited but I can still work with it. (Like I said I'm only struggling to develop the wording of the Dx and the proper concept it would fall under). Just asking for opinions as I will probably be done by the time anyone gets to reply, it's due tonight, but I value the input as far as what direction I take. Okay

M 37Y NKA

Dx Bacteremia: Gram + but otherwise unknown. Hx Hep C., Cirrhosis, MS, DM

Ad lib, NPO, A&Ox3, Tele SR, IV: LAC 18G S/L,

Ascites RUQ, pallor, aggitated, afebril, denies any discomfort

T97.8 P97 R20 BP108/98 O2 98%

Patient was DC'd the night before, though I didn't record the admitting DX for that visit (foul I know), the hospital called him to come back d/t bacteremia. He was pretty restless, seeming a little irritated, later I related that to coping-he couldn't afford to keep missing days of work. His WBC, Hgb, Hct, PLT, Cr, and Ca. are all (out of range) Low. Except his BG I drew of 225 but the RN didn't want to admin Insulin bc he's NPO. I attribute the low CBC values to Hepatitis C though. Paracentesis was performed but no conclusion before I left. So with what I have, my care plan will be centered around care related to the Medical Dx, but I don't have a "wording plan", if that's a thing, for my Nursing Dx, I can't say Infection and I don't think he shows enough s/s for Sepsis.

IDK, I appreciate the feeback

SN L2

[nursej22, MSN, RN]

I think you are on the right track, Ineffective protection refers to the inability to respond to an insult like infection , injury resulting in bleeding, etc.

i don't the Hep C is the correct "r/t", because it does not necessarily impact protection. I would use words like leukopenia, thrombocytopenia, hypoalbumimia (if indeed, that is what they have).

[TxxRN]

delete

[nursej22, MSN, RN]

I think you are on the right track, Ineffective protection refers to the inability to respond to an insult like infection , injury resulting in bleeding, etc.

i don't the Hep C is the correct "r/t", because it does not necessarily impact protection. I would use words like leukopenia, thrombocytopenia, hypoalbumimia (if indeed, that is what they have).

Oops, got that backward. R/t to bacteremia, AEB leuko.....

My bad, or sleepy

[Kuriin, BSN, RN]

Your hospital does not have a sliding scale for patients who are NPO? That is a pretty high glucose and we typically give insulin for those who are NPO if they are above (I believe it is) 160. Aren't they fearful of potential DKA? Also, I always recommend posting the labs even if you say they are abnormal. I think psychosocial is definitely a high priority on this one. Why can't they just give him some ABX and be on his merry way?