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My fellow nursing student and I are working on extra credit homework and we are having a really hard time figuring this out. Below is the case study with the questions **The main things we need to know are whether this person has hypernatremia or hyponatremia---and how do we know if we have SIADH? Thank you SO much Smith is a 73 year old white female with lung cancer, and has been receiving chemotherapy on an outpatient basis. She completed her third treatment 5 days ago and has been experiencing nausea and vomiting for 2 days even though she has been given Zofran orally as directed. Smith's daughter brings her to the hospital where she is admitted to the medical unit. The admitting nurse performs a throughout assessment. Subjective Complains of lethargy, weakness, dizzines, and a dry mouth States she has been too nauseated to eat or drink anything for 2 days Objective Heart rate 100 beats/min, pulse thready BP 100/65 Weight loss of 5 lbs since she received her chemotherapy 5 days ago Dry oral mucous membranes Questions Based on her clinical manifestations, what fluid imbalance does Ms. Smith have? (WE SAID: HYPOVOLEMIA) What additional assessment data should the nurse obtain? (WE SAID: CHECK FOR ORTHOSTATIC HYPOTENSION, RESPIRATORY RATE, LEVEL OF CONSCIOUSNESS, PUPILS, VOLUNTARY MOVEMENT, CAPILLARY REFILL, SKIN TURGOR, TEMPERATURE, EDEMA, AND FEEL TEMPERATURE OF SKIN) What are the patient's risk factors for fluid and electrolyte imbalances? (WE SAID: NAUSEA, VOMITING, NOT DRINKING FLUIDS, AND OLDER AGE) The nurse draws blood for a serum chemistry evaluation. What electrolyte imbalances are likely and why? The physician orders dextrose 5% in 0.45% saline to infuse at 100 mL/hr. What type of solution is this and how will it help Smith's fluid imbalance? (WE SAID: HYPERTONIC; IT WILL RAISE THE OSMOLALITY OF THE ECF AND THEN THE FREE WATER WILL EXPAND THE ECF AND ICF) What are the priority nursing inventions for Smith? (WE SAID: I & O, MONITOR CARDIAC CHANGES AND RESPIRATORY STATUS, SKIN ASSESSMENT, AND DAILY WEIGHTS) Because of the nature of her disease process, Smith is at risk for the development of SIADH. How would the nurse recognize this complication and what is the anticipated treatment? Based on the assessment data presented, write one or more appropriate nursing diagnoses. Are there any collaborative problems?

My question is about the 'related to' in a nursing diagnosis. Can I write my own or do they usually have to be from a book? For example: Constipation r/t inadequate fluid intake (from the book) Constipation r/t decreased fluid volume via excessive urination (my own) (diabetes mellitus) I'm thinking you should be able to write your own because people make specified care plans with details....and some of these already written are so general...yet they can be universal for everyone when charting. Please help! :) Thanks

I have been working on a nursing diagnosis for DAYS and I am having so much trouble with it. We were assigned a disease (Diabetes Mellitus) and we had to pick 3 NANDA stems I chose Risk for Injury, Constipation, & Risk for Infection We then had to write a nursing diagnosis for each I'm having an extremely hard time doing the related/to portion. This is my first nursing diagnosis ever and I'm so unsure. 1.) Risk for injury r/t nerve damage and loss of sensation 2.) Constipation r/t intestinal nerve damage AEB prolonged period without defecation 3.) Risk for infection r/t altered immune function I guess my concern is...should these answers be common sense *such as with constipation...decreased water intake* or can they be in depth with the nerve damage even though I have no idea (I researched why diabetes had constipation) because I'm not a doctor and have no additional information. I also made these up with my own words...should I be going out of the book with already written r/t or is it fine to write my own? I would be willing to exchange some of these NANDA stems if you think it would be easier...such as impaired skin integrity. If you guys could please help me I would appreciate it so much. I am on the verge of tears because I am so frustrated. No one can help me, I can't find information on writing these anywhere, and my teacher won't email me back. http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/C-G.html This website has some stuff (risk for injury, risk for infection) under Diabetes Mellitus. THANK YOU SO MUCH