[MagickalSpiral]

Hello everyone!

I am working on a concept map for a very complex patient.

She was started on Amiodarone 3 weeks ago for a fib (after not responding well to betapace) along with her Coumadin. About 10 days after she started taking the Ami, she developed black, tarry stools which she disregarded. After about 2 weeks of this, she presented to the ED with CP, SOB and was found to have a Hgb of 6.2. After 6 units of FFP and packed RBC's her hgb increased to almost 11. The colo/egd could not find the bleed.

She was still very SOB, on 2L with O2 sats around 95%, diminished lung sounds in the bases with crackles and expiratory wheeze, along with a small amount of ascites. The CXR and CT scan showed bilateral pleural effusions, and ARDS. The doctors finally held the Ami (and gave her Lasix) and she improved dramatically overnight. The next morning there were still crackles, but lung sounds weren't as diminished and the wheeze was not present.

I need to know how to fit these things into my nursing diagnoses, since a lot of her problem seems to be related to the Ami...

Any help will be appreciated!

[Daytonite]

Well, it depends on what your nursing diagnoses are going to be. You know that a medication side effect is the etiology of some of her medical symptoms, so if those symptoms are the defining characteristics for any of your nursing diagnoses, they may be pointing the way to the related factor for your diagnostic statements. You still will need a nursing diagnosis reference to help you out though.

[MagickalSpiral]

I was thinking of the following Nursing Dx:

Decreased cardiac output r/t altered contractility AEB cough, crackles, orthopnea and decreased ejection fraction.

? Ineffective airway clearance r/t (??) AEB dyspnea, diminished breath sounds, adventitious breath sounds, ineffective cough and labored respirations

Fatigue r/t anemia,CHF AEB drowsiness, verbalizations of lack of energy, and increase in rest requirements

Those are where I am so far.. Could the Ami go into ineffective airway clearance? Any other suggestions for Dx??

I feel like I am on the right path, what do you think?

Thanks!

[Daytonite]

Decreased cardiac output r/t altered contractility AEB cough, crackles, orthopnea and decreased ejection fraction.

Ineffective airway clearance r/t (excessive mucous) AEB dyspnea, diminished breath sounds, adventitious breath sounds, ineffective cough and labored respirations

Fatigue r/t anemia, inadequate circulation of blood [can't use a medical diagnosis of CHF as a related factor! CHF can be stated as inadequate circulation of blood.] AEB drowsiness, verbalizations of lack of energy, and increase in rest requirements

Those are where I am so far.. Could the Ami go into ineffective airway clearance? No, not unless you can show that one of it's side effects is responsible for one or more of the patient's symptoms. Did you look up the drug amiodarone? One of its common side effects is CHF. So, if you must show a relationship between the drug and a nursing diagnosis this would be it: Decreased cardiac output r/t altered contractility and medication effect AEB cough, crackles, orthopnea and decreased ejection fraction.

Any other suggestions for Dx?? No.Nursing diagnoses are based on patient symptoms, not medical diagnoses. She's got ascites and had a hemorrhage. Something is going on with her fluid status. What symptoms does she have associated with that which will get you to a diagnosis of Deficient or Excess Fluid Volume.

I feel like I am on the right path, what do you think? The first thing you do when writing a care plan is assemble all the symptoms the patient has, THEN you look for nursing diagnoses that have defining characteristics that match with those symptoms. That's the only way you can customize a care plan. You cannot care plan by medical diagnosis all the time, especially when the patient has other nursing problems, particularly needing help with ADLs going on.