Question

Part 1.
Essay (10 above sentences)
a. What would you do if you have a client/patient with cancer?

Part 2.
Plan of care (ADPIRE format) to address the following possible nursing diagnoses associated with AKI and ESRD:
1. Fluid volume excess
2. Decreased cardiac output
3. Risk for infection

Answer 1

1.careful assist the clients level of anxiety.

2.encourage the client to express his feelings

3.Teach strategies for minimising physical changes providing skin care during radiation therapy

4.Monitor vital signs

5.Monitoring WBCs

6.Protect skin and mucous membrane from injury

7.Teach the principles of maintaining good nutrition

8.Answer for systemic signs of infection

9.Carefully assess and evaluate the type of tissue impairment present

10.

FLUID VOLUME EXCESS

Review patient’s history to determine the probable cause of the fluid imbalance.  
Such information can assist to direct management. History may include increased fluids or sodium intake.

Monitor weight regularly using the same scale and preferably at the same time of day wearing the same amount of clothing.  

Sudden weight gain may mean fluid retention. Different scales and clothing may show false weight inconsistencies.

Monitor input and output closely.  

Dehydration may be the result of fluid shifting even if overall fluid intake is adequate.

Assess weight in relation to nutritional status.  

In some patient with heart failure, the weight may be a poor indicator of fluid volume status.

Poor nutrition and decreased appetite over time result in a decrease in weight, which may be accompanied by fluid retention even though the net weight remains unchanged.
Record intake if patient is on fluid restriction.  

Patients should be reminded to include items that are liquid at room temperature such as gelatin, sherbet, soup, and frozen juice pops.

Monitor and note BP and HR.  

Sinus tachycardia and increased BP are evident in early stages.

Review chest x-ray reports.

DECREASED CARDIAC OUTPUT

Monitor for GI bleeding by guaiac testing all stools for blood.  

Gastrointestinal bleeding is a known complication of renal failure; however, its pathogenesis remains uncertain. Some have attributed gastrointestinal bleeding to the effects of uremia on the gastrointestinal mucosa; others have suggested that uremia may affect platelet adhesiveness, which may explain the prolonged gastrointestinal bleeding seen in patients with renal failure.

Auscultate heart sounds.

Assess color of skin, mucous membranes, and nail beds.

Note capillary refill time.

Monitor BP and HR.

RISK FOR INFECTION

Infections occur when the natural defense mechanisms of an individual are inadequate to protect them.

Organisms such as bacteria, viruses, fungus, and other parasites invade susceptible hosts through inevitable injuries and exposures.

People have dedicated cells or tissues that deal with the threat of infection in the form . These are known as the immune system.

The human immune system is crucial for survival in a world full of potentially deadly and harmful microbes, and serious impairment of this system can predispose to severe, even life-threatening, infections.

Organs and tissues involved in the immune system include the thymus, bone marrow, lymph nodes, spleen, appendix, tonsils, and Peyer’s patches (in the small intestine).

If the patient’s immune system cannot battle the invading microorganism sufficiently, an infection occurs.