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I do have a copy of the Nanda book. I am having a haard time relating cerebral tissue perfussion to this pt. I feel that confussion is my best dx, but like I mentioned my instructor stated she didn't think so. I will look over the impaired memory. I don't know why I'm making this difficult on myself! I've written many careplans I think I'm just having a mental block or maybe missing an important assessment. Thank you for your input.

I've turned in a care plan and my instructor wants me to do another dx Pt was admitted for altered mental status. Hey bf reports that she spent 2 days without getting off couch before she became unresponsive. Paramedics report that pt was breathing and only responded to painful stimuli. It was first believed that pt suffered from stroke but that has been ruled out. There is evidence of renalfailure and UTI. Patient is diabetic, HTN, drinker, obese, and has severe back injuries with pain 8-10 out of 10. I am aware that UTI can cause mental alterations and confussion but this was not indicated by her H&P. At this time the reason for her altered mental status and unresponsiveness is unknown. She presented during my assessment alert and orientated to person, place, time, and event. She did however exibit confusion and STM loss. I've done diagnosis for acute pain (back 8-10 out of 10), skin integrity (pressure ulcers and skin tears), fluid imbalance (edema, crackles bilateral, imbalanced I&Os). My instructor was happy with my dxs but wants me to do 1 more regarding her neuro issue that she was admitted for. I suggested acute confussion and she stated "I don't think that's the best one". Does anyone have any other suggestions for me? I explained to her that I was having a hard time with choosing a dx because the related to factor is unknown. She said it was ok to do r/t unknown reason. THANK YOU!!!

I'm working on my first careplan of the semester and I need a little help! I have a patient 9 day post appy. He is still hospitalized due to an ileus that formed after the surgery. I've done all my assessments and most of my careplan but I am stumped with my last dx. My patient was extremely anxious and "fed up" with being in the hospital. He wanted to DC all orders (NG tube, IV, labs, xray) and be discharged. Through my assessment and communication I learned that he is an active father of 5. He misses his children terribly and feels like he is "missing out" on his family. Since they live 30 mins away and the childrens school/afterschool activities and wifes work sched interfere with visiting, he only gets to see his 2 year old during the week. He also expressed concern for missing work (he works for self and is afraid of losing clients). I can't seem to find the right dx for this situation. I've looked at: anxiety r/t hospital stay Interrupted family proccess r/t patient hospitalized I just can't seem to get this one right. Any help/advise/suggestions are appreciated! Thank You!