i hate to throw another monkey wrench in the works here, but. . .i have a few thoughts for you.
any diagnoses beginning with the words "risk of" are anticipatory problems and should be placed at the bottom of your nursing diagnosis listings. that is in the nanda guidelines.
agree with mlos. you can combine #4 and #6 into one nursing diagnostic statement.
switch #7 with #8. nutrition takes priority over movement on maslow's pyramid in the physiological tier. no food results in a dead patient who isn't going to be moving anywhere. bad way to explain this, i know, but food is more important than movement when it comes to basic needs to sustain life. however, i don't know that your nursing diagnosis #8 is a good diagnosis for you to use, and i will tell you why. the nanda definition of imbalanced nutrition: less than body requirements
is "intake of nutrients insufficient to meet metabolic needs" (nursing diagnoses: definitions & classification 2005-2006
, nanda, page 126). the cause, or etiology, of this, per nanda, same page on the above referenced source, is the "inability to ingest or digest food or absorb nutrients due to biological, psychological, or economic factors". that doesn't sound like the case with your patient unless you have assessment data to support that.
in addition, i don't agree with you about low albumin being a symptom of imbalanced nutrition. there would be other indicators of the imbalanced nutrition such as weight loss, mechanical difficulties with swallowing, not wanting to eat, or lack of interest in food to list a few. low albumin ties in to the endocrine system when it comes to the transport and circulation of lipid-soluble hormones, estrogen being the primary one that depends on albumin. i don't see that as a particular need for this patient. the bigger question i see, however, is why, or how, is this patient losing his plasma proteins? low albumin levels are more likely to be related to cardiac or renal dysfunction. low albumin (albuminemia) can be used as one of the defining characteristics (an aeb) of your excessive fluid volume diagnosis since his edema is undoubtedly, in part, due to his low albumin levels. does this patient have anasarca? you mention he has edema. is this edema throughout his body?
if the patient is already septic, then i can see a better way to take care of any problems with the decubitus ulcer by combining it with the sepsis. i would use ineffective tissue perfusion: cardiopulmonary and peripheral r/t decreased systemic vascular resistance
for the sepsis and the decubitus. the supporting symptoms would be blood culture results (i assume that's how the sepsis was confirmed), the hyperthermia and delayed healing in the decubitus ulcer because of the presence of edema.
this is the way i would sequence the nursing diagnoses:
- impaired gas exchange
- ineffective breathing pattern
- decreased cardiac output (#4 and 6 combined)
- ineffective tissue perfusion
- excessive fluid volume
- activity intolerance
- risk for aspiration
i was wondering if there was some reason why you didn't post your thread on one of the nursing student forums? the only reason i happened to find your post was because i did a search for any recent posts for the keyword "nanda". i do this periodically looking for students who need help with care plans or nursing diagnoses.