[futurenurse85]

hello! i need help coming up with some nursing diagnosis for my patient. he is 66 y/o male admitted with cardiac arrest/acute MI. he underwent CABGx3 yesterday. his current EKG shows atrial fibrillation. he has generalized weakness and generalized edema. he has had a productive cough with thick,brown sputum. his breath sounds are also diminished upon auscultation. he is going to be my patient tomorrow and were not allowed to speak with the patient the day before so this is pretty much all the info i have to go off of. i have thought of some nursing diagnoses but i dont know..they are: activity intolerance, pain, impaired skin integrity, risk for infection, risk for injury (bleeding). are these applicable? oh yeah, when i went in and introduced myself to the patient i asked him how he felt and he was very optimistic about leaving the hospital in 4 days. he wants to hurry up and get better. anyway, i would GREATLY appreciate any input and help with coming up with nursing diagnoses for this patient! thank you so much for your time and have a wonderful day!

[dolphn545]

Not sure how many you need. Here are a few more:

Risk for Decreased Cardiac Output
Fluid Volume Deficit
Fear
Anxiety
Risk for Constipation

[coolvibesRN]

Originally Posted by futurenurse85

hello! i need help coming up with some nursing diagnosis for my patient. he is 66 y/o male admitted with cardiac arrest/acute MI. he underwent CABGx3 yesterday. his current EKG shows atrial fibrillation. he has generalized weakness and generalized edema. he has had a productive cough with thick,brown sputum. his breath sounds are also diminished upon auscultation. he is going to be my patient tomorrow and were not allowed to speak with the patient the day before so this is pretty much all the info i have to go off of. i have thought of some nursing diagnoses but i dont know..they are: activity intolerance, pain, impaired skin integrity, risk for infection, risk for injury (bleeding). are these applicable? oh yeah, when i went in and introduced myself to the patient i asked him how he felt and he was very optimistic about leaving the hospital in 4 days. he wants to hurry up and get better. anyway, i would GREATLY appreciate any input and help with coming up with nursing diagnoses for this patient! thank you so much for your time and have a wonderful day!

These nsg diagnoses are applicable.
Also risk for ineffective breathing pattern, altered role performance r/t situational crisis/recuperative process, risk for decreased cardiac output

[Daytonite]

This is a surgical patient who just had major chest surgery, so you should be reviewing your textbook on the care of surgical patients and the types of complications patients undergoing general anesthesia can develop. Especially, after chest surgery, think about the kinds of things you need to be looking out for. The patient will have a surgical wound, chest tube and may or may not be on a ventilator. You should also be reviewing the CABG procedure. What kind of complications accompany CABGs? What kind of discharge teaching and follow up will he need?

I think you've made some good choices for nursing diagnoses to start off with, but you've totally missed the ABCs. The heart and lungs are closely related and this is the area of his body that was cut into. Keep in mind that your final nursing diagnoses are always going to be based upon your assessment of the patient and not necessarily upon his medical diagnoses. How are you planning to fit his symptoms of atrial fibrillation, weakness and edema into nursing diagnoses? Why does he have generalized edema? What's going on with that? I think you need to look at the definition and defining characteristics of the Deficient Cardiac Output diagnosis since his heart is the organ being given attention to here. Also, attention to the airway is important following surgery and you have nothing that attends to that. Anyone who has undergone general anesthesia at least has a sore throat and resultant sputum production from the presence of the ET tube (foreign body irritation). Pneumonia is a real danger in patients who have had their chest cavity cracked open, so attention to the airway and breathing is paramount! Your patient has thick brown sputum and diminished breath sounds with auscultation and that needs to be addressed with a nursing diagnosis.

[gt4everpn]

Because Of The Generalized Edema, Sputum, Diminished Breath Sound, Along With His Cardiac Situation I Would Have
Decreased Cardiac Output As My Main Diagnosis Then
Ineffective Breathing Pattern
Activity Intolerance Due To Mi&cabg

[futurenurse85]

thank you all so much for your replies! i really appreciate it! here are the nursing diagnoses i came up with in priority order. if you can, PLEASE let me know if they sound okay or if they need to be fixed. thank you!

1. Decreased cardiac output r/t alteration in rhythm, preload and afterload AEB electrocardiographic changes (atrial fibrillation), generalized edema, and crackles auscultated in lungs.

2. Altered breathing pattern r/t surgical procedure AEB diminished breath sounds and oxygen therapy.

3. Impaired skin integrity r/t surgical procedure and invasive line AEB multiple incision sites and right internal jugular central IV line.

4. Activity intolerance r/t pain and weakness secondary to surgical procedure AEB increased pain when moving, verbalization of fatigue and weakness, needs assistance with ambulation and transfers, and oxygen therapy.

5. Altered role performance r/t situational crisis/recuperative process AEB delay in physical capacity to resume role and change in usual responsibility.

[Daytonite]

1. Altered breathing pattern r/t surgical procedure AEB diminished breath sounds and oxygen therapy. [oxygen therapy is not a defining characteristic or symptom of an altered breathing pattern, but an intervention and treatment. The etiology of the inadequate inspiration/expiration is more like "musculoskeletal impairment secondary to surgical procedure". Also, this diagnosis should be sequenced first. ABC's: Airway and breathing take top priority because oxygen is needed first by the brain, then the lungs and then the heart.]
2. Decreased cardiac output r/t alteration in rhythm, preload and afterload AEB electrocardiographic changes (atrial fibrillation), generalized edema, and crackles auscultated in lungs. [What other symptoms of altered preload and afterload do you have beside the generalized edema and crackles in the lung? I can see the altered preload, but I'm not seeing the altered afterload.]
3. Impaired skin integrity r/t surgical procedure and invasive line AEB multiple incision sites and right internal jugular central IV line. [The presence of the internal jugular central IV line is a defining characteristic, or symptom, that supports the fact that you have impaired skin integrity. However, I would list the etiology of a central line as either an "invasive procedure" or "medical procedure" and give specific information on the incisions and invasive lines so that this nursing diagnosis reads something like: Impaired Skin Integrity R/T surgical and medical procedures AEB thoracotomy incision, peripheral leg incision and right jugular central line.]
4. Activity intolerance r/t pain and weakness secondary to surgical procedure AEB increased pain when moving, verbalization of fatigue and weakness, needs assistance with ambulation and transfers, and oxygen therapy. [oxygen therapy is a treatment and I would replace it with the abnormal assessment data that is the reason for needing the oxygen, such as shortness of breath with activity]
5. Altered role performance r/t situational crisis/recuperative process AEB delay in physical capacity to resume role and change in usual responsibility.

This patient is coughing up thick, brown sputum, his breath sounds are also diminished upon auscultation. I would give him a nursing diagnosis of Ineffective Airway Clearance R/T retained secretions and/or secretions in the bronchi secondary to the presence of a ET tube during surgery and/or infective process AEB production of thick, brown sputum and diminished breath sounds and crackles upon auscultation of the lungs. That brown color in his sputum is probably old blood which makes me think he's either coughing too hard, coughing out some drainage from the surgical area or he's got a case of pneumonia going. I would sequence it after the Altered Breathing Pattern and before the Decreased Cardiac Output. I'm intrigued by the patient's generalized edema. Since he came in with an MI and has had a CABG I'm wondering if there is some congestive heart failure going on here which is not an uncommon complication in these patients. Symptoms of that would also be better evidence of what is going on with the cardiac output situation and whether there is a problem with preload, afterload, or both. Without evidence to support decreased cardiac output, I would entertain a nursing diagnosis of Excess Fluid Volume due to the patient's edema and lung congestion. I don't see a need for the diagnosis of Altered Role Performance. A "risk for" it, maybe. However, but I don't see any supporting evidence for it.

Just my thoughts.

[nghtfltguy]

where were all of you great people when i was in nursing school??