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This Concept Map, created with IHMC CmapTools, has information related to: C-map for GS, ???? ???? Problem #2 Acute Pain R/T Renal Failure Goal-Pain is rated at 3 or less within 30 minutes of intervention Assessment Restlesness Unable to sleep Rates pain at 6 (1-10 scale) B/P 164/90 P-65 T-97.6 R-20 Decreased Appetite NI Use analgesics appropriately. Use non-analgisic relief measures Instruct to report uncontrolled pain to healthcare provider Outcome Patient will report pain at 3 or less (1/10 scale), experience decreaed relestness, and experience no change from baseline in vistal signs., ???? Problem #3 Altered Renal Perfusion R/T Glomerular Malfunction Goal-Patient will have decreased peripheral edema of +2 wihtin 48 hours of admission Assessment Lungs-CTA +3 pitting edema bilatral feet skin pink warm and dry NI Assess edema evey shift Auscultate breath sounds every shift Measure I & O Daily Weight Place Foley if need more accurate measurement Outcome Patient will have 30 cc's or greater output in24 hours., ???? ????, ????, ???? ???? PATIENT HISTORY G.S. DM Type II Coronary Artery Disease (CAD) LAD 60%/RCA 40%/Mid and Distal RCA 70% Femoral stenting (1996) Metabolic Syndrome Hypertension End Stage Renal Disease (ESRD) Hyperthyroidism Arthritis Hx of diarrhea Former smoker (90 pack years)Quit 1996 Significant weight loss and decreased appetite Started dialysis 3 weeks ago (makes minimal urine) Thrombocytopenia Platelets 77,000 Spontaneous ecchymosis Bleeding at port site Risk Factors: Family History (M,F,B,S) Weight 233# BMI 34.98 Age 65 Sedentary lifestyle Activity Intolerance Lab Results Platelets 77 AIC-9.6 UA Nitrite (+) protein (+) blood (+) glucose (+) bilirubin (+) ketones (+) BUN-48 Creatinine 4.28, ???? ???? PATIENT HISTORY G.S. DM Type II Coronary Artery Disease (CAD) LAD 60%/RCA 40%/Mid and Distal RCA 70% Femoral stenting (1996) Metabolic Syndrome Hypertension End Stage Renal Disease (ESRD) Hyperthyroidism Arthritis Hx of diarrhea Former smoker (90 pack years)Quit 1996 Significant weight loss and decreased appetite Started dialysis 3 weeks ago (makes minimal urine) Thrombocytopenia Platelets 77,000 Spontaneous ecchymosis Bleeding at port site Risk Factors: Family History (M,F,B,S) Weight 233# BMI 34.98 Age 65 Sedentary lifestyle Activity Intolerance Lab Results Platelets 77 AIC-9.6 UA Nitrite (+) protein (+) blood (+) glucose (+) bilirubin (+) ketones (+) BUN-48 Creatinine 4.28, ???? ???? PATIENT HISTORY G.S. DM Type II Coronary Artery Disease (CAD) LAD 60%/RCA 40%/Mid and Distal RCA 70% Femoral stenting (1996) Metabolic Syndrome Hypertension End Stage Renal Disease (ESRD) Hyperthyroidism Arthritis Hx of diarrhea Former smoker (90 pack years)Quit 1996 Significant weight loss and decreased appetite Started dialysis 3 weeks ago (makes minimal urine) Thrombocytopenia Platelets 77,000 Spontaneous ecchymosis Bleeding at port site Risk Factors: Family History (M,F,B,S) Weight 233# BMI 34.98 Age 65 Sedentary lifestyle Activity Intolerance Lab Results Platelets 77 AIC-9.6 UA Nitrite (+) protein (+) blood (+) glucose (+) bilirubin (+) ketones (+) BUN-48 Creatinine 4.28, ????, Problem #3 Altered Renal Perfusion R/T Glomerular Malfunction Goal-Patient will have decreased peripheral edema of +2 wihtin 48 hours of admission Assessment Lungs-CTA +3 pitting edema bilatral feet skin pink warm and dry NI Assess edema evey shift Auscultate breath sounds every shift Measure I & O Daily Weight Place Foley if need more accurate measurement Outcome Patient will have 30 cc's or greater output in24 hours. ???? ????