ok.. here's the patient..
med surg patient admitted with altered loc, hypokalemia, uti and dvt. hx of anxiety, depression, bipolar disorder, schizophrenia, ams, hypokalemia, uti, ari, anemia, she also claims 8 different personalities. the day i took care of her, the k+ was 3.7; h&h low 9.4 and 26.5 respectively. her ca (6.7), ph (1.5), and mag (1.2) which is also low and were replaced that day. the inr is 2. patient has a foley in. vs throughout shift were wnl. intake 1740 output 1700. no complains of pain except for a ha at 5/10 that was medicated with 325 mg of acetaminophen and after 1 hour she states pain of 1/10. left leg was edematous. patient was confused during shift and a&o x1 (self) the possible dx that i have are: 1st ill do the ineffective peripheral tissue perfusion r/t decreased blood flow to extremities aeb tissue edema and diminished peripheral pulse to right leg. the other one i'll use (my teacher said it would be a good one) is risk for injury r/t ↓ loc and with that i'll adress her hx and hypokalemia and also uti can cause confusion, right? well i was thinking risk for infection r/t ↓ h&h, but she already has one (uti) and the teacher kinda didn't like that one. another one was impaired urinary elimination r/t impairment in neurological sensing and control aeb inability to go to recognize the need to void - but i think that's more for people with spinal cord injuries because the interventions didn't really apply to my patient. so i'm feeling like out of ideas... what do you guys think of the following? we have to do it in order of priority. my teacher says " what can kill the patient first?" so i have these other options. altered loc - impaired memory r/t neurological disturbances (can't really kill you, can it?), risk for impaired skin integrity r/t immobility (risk for falls, patient was in bed and what not), and the other one fatigue r/t ↓ h&h. i don't know what to think of it anymore.
thanks.. i appreciate it!