What would be a priority d/x w. untreatable cancer?

[Hellostudentnurssee]

NOTE: Not a real life patient - just a "patient" from a scenario.

Pt has "multiple myeloma" which is not treatable. I know this pt can possibly go into renal failure so I was thinking my first important priority d/x is:

"Fluid imbalance" - it's also important for cancer patients like him to stay hydrated

however, he does have "chronic pain" (obviously due to this cancer), especially when he repositions in bed. The thing is my instructor doesn't like the "chronic pain" d/x used in our care plans (don't ask, she's got weird preferences). So I was thinking of putting:

"Impaired comfort r/t chronic pain and effects of cancer"

And third, he was going through alot of psychological issues. This is what I dealt with the most that shift. He was scared of dying (which the doctor was very anxious and communicating it to him that made him feel more pressured and scared). So my last d/x would be "fear" d/x

Do you think those would be good d/x? Which one would go first? I'm debating between "fluid imbalance" vs "impaired comfort".

Thanks everyone!

[nurseprnRN, BSN, RN]

if you were in the bed with that medical diagnosis, what would you want your nurse to do for you most?

pulling out my nanda i can find many, many potential nursing diagnoses from which to develop a nursing plan of care just by sorta flipping thru the pages. the sections are:

health promotion

nutrition

elimination/exchange

action/rest

perception/cognition

self-perception

role

sexuality

coping/stress

think anything could go wrong in any of those areas that nursing could address? go look.

[bols27]

It depends on what unit he is going to be on. I would assume he is going to be in palliative care or hospice? If this is the case I would say that pain control and coping would be the most important issues. I would also be mindful of any family members and their ability to cope with his imminent death. If he chooses to life out his days at home then you really need to focus on teaching and family education if applicable. I suppose since it is myeloma you would also be concerned with risk for infection as well as anemia and risk for injury related to neurological deficits. It all depends on what stage he is and what symptoms are manifesting. You could even put something in there about nutrition. Also, is having any kind of treatment? Myeloma is not "untreatable" it is incurable but can be sent into remission with heavy doses of steroids, chemo, and radiation...all of which would put him at a HUGELY increased risk for infection.