Question

Create a conceptual map using the case scenarios as guide. Conceptual map should include pathophysiology, medical diagnosis, signs and symptoms, and risk factors, if any. Nursing diagnosis, nursing interventions, medical management (medication and procedures), expected outcomes

A 37-year old man with chronic renal failure who was secondary to chronic glomerulonephritis had been on peritoneal dialysis for approximately 6 months without any episode of peritonitis. In December 2019, he was admitted to the hospital for fever, vomiting, abdominal pain, diarrhea, and cloudy dialysate several hours after eating stinky tofu. The peritoneal effluent culture yielded Aeromonas Sobria. The patient was given levofloxacin for 10 days. The patient symptoms such as diarrhea, abdominal pain were relieved and the cloudy effluent turned to be clear. Unfortunately, peritoneal dialysis catheter was blocked because of fibrin clot formation in the setting of inflammation, and finally it was removed.

Answer 1

Nursing diagnosis:

· Risk for Decreased Cardiac Output

Nursing interventions:

· Auscultate heart and lung sounds. Evaluate presence of peripheral edema, vascular congestion and reports of dyspnea.

· Assess presence and degree of hypertension: monitor BP; note postural changes (sitting, lying, standing).

· Investigate reports of chest pain, noting location, radiation, severity (0–10 scale), and whether or not it is intensified by deep inspiration and supine position.

· Evaluate heart sounds (note friction rub), BP, peripheral pulses, capillary refill, vascular congestion, temperature, and sensorium or mentation.

Medical management (medication and procedures),

Dialysis (haemodialysis or peritoneal dialysis) and kidney transplantation.

Immunosuppressant medicines

         In the given cases patient takes levofloxacin for 10 days.

Expected outcomes:

Maintain cardiac output as evidenced by BP and heart rate within patient’s normal range; peripheral pulses strong and equal with prompt capillary refill time.