Chief Medical Diagnosis : Right foot cellulitis, osteomyelitis

1. Risk for Excess Fluid Volume *Lasix 80mg bid (side effect) *impaired renal function-Hx chronic renal failure *daily weight *HTN Pain *8/10 burning pain *Neurontin 300mg tid *Lyrica 75mg bid *Morphine prn *Prilosec 40mg/day ac *Right foot ulcer *Hx neuropathy Risk for Injury *Neurontin 300mg tid *no BP or labs in left arm due to dialysis shunt *Phoslo 1 CAP tid *Lyrica 75mg bid(adverse reaction) *Lovenox sc 30mg/day (side effects) *Diovan 160mg q am (adverse reactions) *Ambienprn *Prilosec 40mg/day ac Risk for Impaired Skin Integrity *permacath right chest *A-V fistula L arm *Hx diabetic ulcers *diabetic ulcer to right foot Ineffective Tissue Perfusion *Lovenox sc 30mg/day *Norvasc 10mg/day *HGB 12.8 L *HCT 33 L Risk for Noncompliance *pt. out of medications 2 days prior to admittance *diabetic and HTN medications and injections Chief Medical Diagnosis: Right foot cellulitis, osteomyelitis Priority Assessment: infection, nutrition status, pain Disturbed Sleep Pattern *Ambienprn Impaired Urinary Elimination *BUN 38H *CREAT 6.05 H *Lasix 80 mg bid *Hx chronic renal failure *Hx kidney stones Altered Nutrition *Phenergan prn < *N/V < *diarrhea < *Na 132 L < *K 3.4 L < *glucose 184 H > (diabetic) *I&O *cardiac renal 1800 cal diabetic diet *daily weight *Nephrocaps 1 CAP bid < *Niacin 500mg/day < *Phoslo 1 CAP tid < *HTN > *Sliding scale Humalog insulin > *Novolog 10U > Infection *Hx decubitus ulcers of the right foot *advanced right foot diabetic ulcer with osteomyelitis *Flagyl 500mg q 6 IV *Cefazolin 2 Gm q 12 IV *Cipro/Avelox 400mg q24 IV *Lymphocytes 19.1% L *Monocytes 10.1% H *ordered stool sample for C-diff *permacath right chest *AV fistula left arm Risk for Decreased Cardiac Output *Lopressor 25mg bid *Lisinopril 10mg/day (side effect)