i'm doing a careplan & concept map on a patient with pvd (neuropathy, leg ulcers, cellulitis, the whole shebang) and one of the comorbs is end-stage renal disease. thus, one of my nursing diagnosis is impaired tissue perfusion r/t diminished oxygen transport secondary to decreased erythropoietin production secondary to renal failure.
this patient also has htn, chronic hyperlipidemia, and multiple femoral stents- her femoral arteries are >50% stenotic with seriously impaired distal flow. so not only does she have a diminished blood supply, whatever blood she does have can't get to where it needs to go. that's why i would like to use this diagnosis as well: impaired tissue perfusion r/t blood flow interruption secondary to atherosclerotic plaques secondary to chronic hyperlipidemia a/e/b multiple lower extremity stents, peripheral neuropathy, weak peripheral pulses, prolonged capillary refill, and delayed wound healing.
so, is it okay to use the same nursing diagnosis twice in the same careplan, if the r/t's are completely different?
my are prioritized concept map diagnoses are below. i was hoping that if i could use both impaired perfusions, i could get rid of the impaired physical mobility.
1.1 impaired tissue perfusion r/t diminished oxygen transport secondary to decreased erythropoietin production d/t to renal failure.
1.2 impaired tissue perfusion r/t blood flow interruption secondary to atherosclerotic plaques d/t hypertension and chronic hyperlipidemia .
2. impaired tissue integrity r/t ischemia and inflammatory process secondary to infection.
3. chronic pain r/t tissue damage secondary to infection and chronic inflammation. (fyi, infection is e. coli bacteriemia)
4. impaired physical mobility r/t chronic pain secondary to tissue damage, sedentary lifestyle, and obesity.
yes, i have all the a/e/b's to back up the diagnoses, i just didn't want to type them all out.
thanks so much!