bjb12

My pt had hyperchloremic metabolic acidosis, insulin dependent diabetes mellitus, chronic kidney disease stage 4, HTN. This is the dx that I know is too long: Fatigue r/t oxygen deficiency r/t low RBC's and low hgb levels r/t improper production of erythropoieton by diseased kidneys which stimulates the bone marrow to produce the proper number of RBC's needed to carry Oxygen to vital organs AEB Hgb 9.5 and RBC 2.96 and GFR 20. I'm putting too much info in there so my instructor knows I understand why the pt is fatigued d/t low rbcs and hgb bc her kidneys are bad... but I don't know which part to just throw out. I guess I've been staring at it too long. Others I'm using: Risk for impaired skin integrity r/t decreased sensation and circulation to lower extremities AEB dry skin on ankles and shin areas. Risk for imbalanced fluid volume (still working on the rest) Ineffective tissue perfusion: Renal (still working on rest) Once I get rolling I'm good... its just getting that initial dx going.

Thank you very much for the info. I turned the care plan in, but I will probably be getting it back with things to "fix." So I'll be able to add this information to it. :)

I have a patient presenting with pulmonary edema. My instructor wants me to develop a cardiac care plan that has to do with how pulmonary edema. I have EKG results and I don't know how to read them. 7/2/10 HR 104 PR Interval 154 P Wave Frontal axis 35 QRS duration 78 QRS Complex Frontal axis -1 QT Interval 326 QT Interval Corrected 404 T Wave Frontal Axis - 1 7/3/10 HR 89 PR Interval (ms) 146 P Wave Frontal axis (deg) 47 QRS duration (ms) 88 QRS Complex frontal axis (deg) -1 QT Interval (as) 342 Qt interval corrected 393 T Wave Frontal axis -1 These numbers seem high and I don't know what kind of lead they were using... and I have no clue how to interpret them and I understand that hypoxia can lead to arrythmias. This pt has a hx of paroxamal supraventricular arrythmias although during her hospital stay she didn't have an extremely elevated HR. She has hx of SLE, DVT, GERD... but her hospital dx was atypical pneumonia, pulmonary edema, dyspnea, and hypoxemia. Her Pulse ox was 94% even on O2. Any help is appreciated.

Thank you both. I appreciate it! :-)

I am doing a care plan on a patient who came in who had fallen, was 36 weeks gestation, and wanted to make sure that everything was okay with the baby. I understand that my care plan is mostly going to be "risk for" because other than some bumps and bruises, she was in okay shape. Risk for bleeding r/t possible placental abruption r/t fall 1. assess fetal heart rate via monitor - to monitor for s/s of fetal distress. Make sure there is good variability. 2. Assess for any contractions - increasing amt/strength of contractions can be indicative of early labor 3. Asses for lady partsl bleeding - lady partsl bleeding can indicate early labor 4. Assess LOC - altered LOC may indicate low fluid volume and bleeding 5. Assess for abdominal pain and cramping - placental abruption causes the mother severe abdominal pain 7. Assess BP q 15 min - Low BP indicates hemorrhage and is a late sign of a maternal bleed 8. Monitor BP for orthostatic changes - postural hypotension is a common manifestation in fluid loss >10mm Hg drop = circ blood volume is decreased by 20% >20-30mm Hg drop = circ blood volume is decreased by 40% 9. Monitor and document VS - sinus tachycardia may occur with hypovolemia to maintain an effective cardiac output. Usually the pulse is weak and can be irregular. Hypotension is evident in hypovolemia. GOAL: Patient will experience adequate fluid volume AEB normotensive BP and HR That's what I've got so far. I'm thinking.... RISK FOR PAIN... could be one... And I'm kind of reaching if I go with risk for infection because of the small abrasion to her knee... Any other good nursing diagnosis'? Any input is appreciated! Thank you!