Quote from tidwella980
Okay so I my instructor wants us to come up with three nursing diagnoses and then pick one to create a care plan. Here's what I have so far:
1. Acute pain r/t obstruction of pulmonary arterial blood flow aeb pain 10/10 and evidence of embolus.
2. Impaired gas exchanged r/t altered blood flow to alveoli secondary to lodged embolus aeb shortness of breath.
3. Ineffective peripheral tissue perfusion r/t deep vein thrombus formation aeb swollen left leg, 5/10 pain with mottled erythema.
Are these done accurately? I wasn't too sure about the priority. I know that breathing is the 1st, but with this patient, it says it was upon admission and now Dr. has ordered he be on O2 therapy. The reason I put pain first was because pt. stated pain being 10/10.
This is pertaining to the case study I posted in the original post.
Thanks so much for everyone's input! It really means a lot. I just want to make sure I am doing this accurately. I know that this is a very important skill to master!
YOU are thinking in the right direction. Your critical thinking is on the right path. Priority has nothing to do with the presentation....if someone came in for a broken arm and proceeded to have a heart attack...the heart attack becomes the priority. Do you have a care plan book? Which one do you have?
Looking at your presenting scenario, your answer is there....... is a 70 year old male who presented at the ER with chest pain and shortness of breath
. The history shows he has had a swollen leg with pain for 4 days prior to coming to the ER. He is admitted to your unit. He has significant swelling and mottled erythema of his left leg pain 5/10 while his chest pain is 10/10. The electrocardiogram shows he has atrial fibrillation. The diagnostic work shows that he has a large thrombosis in the left popliteal vein and evidence of a pulmonary embolism. The doctor has ordered he be started on IV anti-coagulation therapy, best rest and O2 therapy. Physical assessment reveals diminished breath sounds in the bases. BP 130/80, P 106 and irregular, R 22, T 99 F.
so.........your patient has chest pain that is a 10 out of 10. He has evidence of a Pulmonary embolism. From your research you have discovered that Patients with Pulmonary embolism can code and die as well as suffer from severe hypoxia.
Pulmonary embolism is a common and potentially lethal condition. Most patients who succumb to pulmonary embolism do so within the first few hours of the event. Despite diagnostic advances, delays in pulmonary embolism diagnosis are common and represent an important issue.As a cause of sudden death, massive pulmonary embolism is second only to sudden cardiac death
medscape requires registration but it is free. It is full of sources and articles that are EXCELLENT.Medscape: Medscape Access
Therefore.....your patient has
1) Acute pain R/T obstruction of pulmonary arterial blood flow due to pulmonary embolism AEB verbalized chest pain rated 10/10
2) Impaired gas exchanged r/t altered blood flow to alveoli secondary to lodged embolus causing a blockage in the pulmonary artery or one of its branches AEB shortness of breath. (normally there would be an O2 sat documented and/or ABG's: arterial blood gasses to document hypoxia)
3) Ineffective peripheral tissue perfusion R/T deep vein thrombus formation AEB swollen left leg, 5/10 pain with mottled erythema.
See where this goes?