Which data set is an example of a cue cluster?
a. Thirst, dry skin, dry oral mucous membranes, increased body temperature, decreased urine output
b. Elevated TSH, tachycardia, tachypnea, dry skin, anxiety, irritability, Kussmaul respirations
c. Kussmaul respirations, oliguria, polydipsia, polyphagia, low TSH, generalized discomfort
d. Elevated white blood count, neutropenia, dyspnea on exertion, generalized weakness
A
Thirst, dry skin, dry oral mucous membranes, increased body temperature, and decreased urine output is a cue cluster that identifies deficient fluid volume as a nursing diagnosis. Data clustering occurs when related cues are grouped together. An elevated TSH level indicates a patient is hypothyroid, and yet tachycardia, tachypnea, anxiety, and irritability all indicate hyperthyroidism. Kussmaul respirations are found in diabetic ketoacidosis. Kussmaul respirations refers to diabetic ketoacidosis in which polyuria (not oliguria) is an expected finding. An elevated white blood count is not an expected finding in a patient who is experiencing neutropenia.
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