futurern4

Good morning. I have a big careplan that I'm working on. I'm finishing up my first clinical rotation in med/surg. This quarter has been hard, but I've had many lightbulb moments at the same time. My instructor said that this is the quarter when students begin to start thinking like nurses. The patient that I took care of at the hospital the other day was admitted for severe sepsis, and hypotension. I'm good with the pathophysiology of it & how the 2 are related, but I have to come up with nursing dx, and this lady was far more complicated then what I thought she was going to be when I chose her. Turns out, she is in end stage renal failure, getting dialysis, she had a nephrectomy, has a dvt, altered mental status, VRE, Cdiff, bil buttocks with stage 2 ulcers, diabetic, hx of hypertension, cancer multiple sites. Gosh I hope I didn't leave anything out. She was also bedridden, blind, hard of hearing. I'm doing the careplan based on what her admitting dx was, so I'm focusing on the sepsis, and hypotension. I will put the nursing dx in order of what I think the priority diagnoses are, and if someone could just offer some input or guidance, that would be great :) For sepsi I have- Ineffective tissue perfusion, imbalanced nutrition, and risk for shock. For hypotension I have-decreased cardiac output, risk for ineffective cerebral perfusion, risk for ineffective renal perfusion, and risk for shock. My question is... 1. Could someone shed a little light on as the "as evidence by" part of the careplan, what am I putting in that section? 2. the at risk for ineffective renal perfusion is questionable because she is already in renal failure, so do I use this dx? 3. How do I make long term goals if she is being dc'd to a nursing home? I know this is a long and involved question, I'm trying to provide as much info as possible.. Thanks so much for the help. :)

Update!!!! After reading the link, and investigating in my drug book, I know the answer!! I would give the Albumin First, because it's going to pull the fluid from the extravascular space, back into the intravascular space, then I would give the Lasix to remove the excess fluid!!!! Thank you, Thank you, Thank you!!!!!:)

Wow!! qcc2011grad! That link you shared with me was Awesome!! I wish I would have had this when I was learning about fluids and electrolytes.. It was really helpful, I'm going to share this with my classmates, and instructor. Although we have already been thru this a couple of quarters ago, it keeps popping back up, and this link explains things really well!! I'm taking my test this morning, and am feeling better! Thank you soooo much!!

Thank you both very much:)

Good Morning.. I am a nursing student with a question that is on my study guide for a test on Tuesday. If anyone could help me I would greatly appreciate it!! Here is the question... What is the purpose of IV albumin and lasix; which would you administer first for a pt. who is in fluid overload and has Ascites ? What is the rationale for your action? I know the purpose of the 2 medications.. I think I would admin the Lasix first, but I cannot find a concrete answer anywhere.. Thank you:)