Question

Taking into consideration all of his health problems, what are the top 5 priority nursing diagnoses for him?

What would be appropriate outcomes for each diagnosis?

What are some appropriate interventions for each diagnosis (remember to include MD orders as well as nursing actions, and note that there might be a lot of overlap in terms of interventions for different diagnoses)?

Your patient is a 92-year old male who was just admitted to your med/surg unit through the ED for dehydration, hypokalemia, and gastroenteritis of unknown etiology. His past medical history indicates that he has had COPD for 26 years. His COPD has been characterized by a mixture of emphysema, chronic bronchitis, and reactive airway symptoms. 8 years ago he developed right-sided HF, and after a knee replacement 5 years ago his HF became bilateral, and he developed atrial fibrillation. He has HTN, chronic renal insufficiency, and Type 2 DM. His meds include: 3 inhalers - tiopropium, salmeterol/fluticasone, and albuterol prn; and the following PO meds - digoxin, furosemide, warfarin, prednisone, theophylline, lisinopril, metoprolol, metformin, and glipizide. Upon admission his VS were P 108, RR 32, BP 98/52, T 99, and O2 sat by pulse oximetry 90% on room air. He is oriented, but states he is too tired to answer questions. Lung sounds diminished bilaterally, extra heart sounds noted, bowel sounds hyperactive and high-pitched. His wife states he has had approximately 12 loose BMs in the last day, and that this is the third day of severe diarrhea, nausea, and vomiting. She does not know when the last time he voided was, and states that he has continued to take all of his medications, except his diabetes pills, which he stopped taking because he hasn’t been eating .

He also had the following diagnostic results:

ABGs: pH: 7.25 CO2: 50 HCO3: 25 PaO2: 84 SaO2: 90%

CXR: changes consistent with COPD, enlarged heart

EKG: atrial fibrillation 2-D

Echo: left ventricular hypertrophy with 25% EF

CBC & METABOLIC PANEL: HGB: 19 HCT: 58 WBC: 8 BUN: 59 CREAT: 2.8 Na: 155 K: 2.8 Cl: 110 Ca: 8 PO4: 5.1 Mg: 1.2 Glucose: 987 Pre-Albumin: 15 Albumin: 2.9 Total protein: 4.8 INR: 3.5 Digoxin level: 1.9 Theophylline level: 24

Answer 1

Diarrhea related to gastroenteritis

Assessment	Diagnosis	Goal	Nursing interventions	Evaluation
Subjective data The patient has verbalized about he is not having adequate bowel movements Objective data The patient looks Tired Dehydrated Fatigue	Diarrhea related to gastroenteritis	After the nursing interventions the diarrhea will be resolved and the patient will be back to the early stage	1) Assess the baseline data 2) Advice the patient to avoid fibre rich diets 3) Monitor intake and output chart 4)Check the weight of the patient 5) Administer antidiarrheal as per the doctor's order.	The patient gastroenteristis will be solved as evidenced by the intake and outpot chart monitoring

High risk for renal abnormalities related to hypokalemia.

Assessment	Diagnosis	Goal	Nursing interventions	Evaluations
Subjective data The patient has been told tha he is having severe diarrhea in last two days Objective data The serum pottasium level is 2.8	High risk for renal abnormalities related to hypokalemia	After 2 days of nursing interventions the patient's pottasium level will become normal and he will be bach to the normal stage	1) Assess the baseline data 2) Check the serum pottasium level of the patient 3) Perform the kidney funtion test 4) Advice the wife to provide pottasium rich foods such as babana,fruit juices,watermelon and green leafy vegitables 5) Administer oral or IV pottasium supplimentations as per the doctors orer	Goal met The patient has relieved from hypokalemia sa evidenced by the serum pottasium monitoring

Imbalanced nutritional status less than body requirements related to less food intake

Assessment	Diagnosis	Goal	Nursing interventions	Evaluation
Subjective data Patient complaints tht he is very tired Objective data The patient is having a rapid change in body weight	Imbalanced nutritional status less than body requirements related to less food intake	after 5 days of nursing care the patient will be relieved from the imbalanced nutritioanl status and back to the early stage	1) Check the baseline data 2) Understand the likes and dialikes of the patient related to diets 3) plan menu for the patinent wilth the help of a dietrician 4) Advive the patient to take mote fluids 5) Advice the patient's wife to provide food at correct time Administer IV infussion as per the physician's order	Goal met The patients nutritional status has been maintained as evidenced by the weight monitoring and the facial expression of the patient.

Fluid and electrolyte imbalance related to dehydration

Assessment	Diagnosis	Goal	Nursing interventions	Evaluation
Subjective data The patinet has verbalized that he is suffering with dehydration Objective data Weight loss Sunken eyes Tired Coated tounge Dry skin Hypokalemia	Fluid and imbalance related to enteritis	After 3 days of nusing interventions the fluid and electrolyte will become balanced	1) Assees the baseline data 2) Monitor the serum electrolyte levels 3) Maintain the intake and output chart 4) Advice the patient to drink oral rehydration solution 5) Replace the electrolyte by the IV infusion 6) Administer anti emetics as per the doctor''s order 7) Administer anti diarrheal as per the doctors order	Goal met The fluid and electrolyte has been maintained well as evidenced by the intake output chart and serum electrolytr test

Activity intolerance related to inadequate energy status

Assessment	Diagnosis	Goal	Nursing implimentation	Evaluation
Subjective data The patient has complains that he is not able to perform activitites of daily living by his own. Objective data The patient is always seeking for the help to do the activities of daily living.	Activity intolerance related to inadequate energy status	After 5 days of the nursing interventions the patient will be able to do the activities independantly	1) Assess the base line data 2) Monitor the patient sleeping patten 3) Provide adequate sleep and rest during night time 4) Provide the psychological support 5) Assist the patient when ever it is need 6) Provide the assissting aids if needed for the patient 7) Encourage the patient to do the activities of daily living by his / her own	Goal met The patient is able to do the activities of daily living by his own