Question

A 50 year old truck driver has been diabetic and has required insulin therapy for the past 20 years. Diabetic neuropathy has led to several complications, including end stage renal disease, which he developed two years ago. He now receives hemodialysis 3 times a week and has an AV fistula in his left forearm. Yesterday, C.S presented in the ER with respiratory infection and was hospitalized with pneumonia, hypertension, and fluid overload. He will receive dialysis while on your nursing unit.

1. List 3 nursing diagnosis, interventions, and patient teachings.

Answer 1

Nursing diagnosis

1. fluid volume deficient related to osmotic diuresis from hyperglycemia

Interventions

* monitor orthostatic blood pressure changes

* monitor respiratory pattern.

* monitor temperature,skin,color and moisture

* assess peripheral pulses,capillary refill,skin turgor and mucus membrane

* monitor input and output

2 . risk for deficient fluid volume.risk factor may include ultrafiltration fluid restriction and actual blood loss such as systemic heparinization or disconnection of the shunt.

Intervention

* measure all sources of intake and output.

* weight daily as well as before and after dialysis run.

* monitor vitals signs during dialysis

* ascertain whether diuretics and antihypertensive are to be withheld

* verify continuity of shunt or access Catheter.

* apply the external shunt dressing permit no puncture of shunt.

3. Ineffective airway clearance Related to the increased production of respiratory secretions

* encourage deep breathing exercise

* assist patient in coughing exercises

* increase fluid volume asked doctor order

* assist patient in to moderate high back rest position

* asses the patient breathing pattern

Patient teaching

* learn basic information about diabetes and its management

* understand to how to use diabetes devices,such as glucometer, insulin pens

* nutrition education and adopt Healthy eating planning, weight loss strategies

* develop problem solving strategies and skills to self manage diabetes.

* to stop smoking and drinking

* do the exercise daily

should be follow balanced diet asper doctor order.