diagnosing is based on the signs and symptoms that the patient has. these come from the assessment that was done. the only symptoms that you've given about this person are:
- dyspnea - this is a component of several nursing diagnoses so more respiratory assessment is needed
- decreased activity - this needs more specific clarification
with copd and asthma i would expect this patient to have adventitious lung sounds, abnormal abgs, some coughing, sputum production, elevations in heart and breathing as well as b/p with activity. with diabetes and obesity i would look for abnormal blood sugars and evidence that the patient doesn't eat the right diet. is there any evidence of complications of the diabetes? can his hypertension be linked to heart disease or cad which is a complication of diabetes? does he have any edema? what is this leukocytosis about? does he have an infection? chronic bronchitis, perhaps, because of his smoking?
you cannot use any nursing diagnosis unless there is evidence to support it. a detective doesn't arrest someone for murder unless they have evidence that indicates the suspect probably did it. likewise, you can't assign a diagnosis to someone without evidence indicating the problem exists. nanda publishes a definition, defining characteristics (signs and symptoms) and related factors for each diagnosis. this is called the taxonomy. this information should be listed in the care plan book you are using, but if it is not you can find this information:
ineffective airway clearance
- in the appendix of taber's cyclopedic medical dictionary
- on two websites that have information for a total of about 80 of the most commonly used nursing diagnoses that you can access for free:
this diagnosis is the inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway. it is used with copd and asthma when patients have dyspnea and adventitious lung sounds which are indicative of retained secretions. active smokers are always producing and hacking up sputum, so this is an appropriate diagnosis to use.imbalanced nutrition: more than body requirements r/t wt . & decreased activity need a psychosocial dx
there is no assessment evidence that points to a psychosocial problem. smoking, if the patient will not quit, is a risk-prone health behavior, but you need evidence to support using it. if he is willing to quit, then, deficient knowledge, smoking cessation can be used.