Care plan help please.. Care plan help please.. | allnurses

LEGAL NOTICE TO THE FOLLOWING ALLNURSES SUBSCRIBERS: Pixie.RN, JustBeachyNurse, monkeyhq, duskyjewel, and LadyFree28. An Order has been issued by the United States District Court for the District of Minnesota that affects you in the case EAST COAST TEST PREP LLC v. ALLNURSES.COM, INC. Click here for more information

Care plan help please..

  1. 0 Hi all, I got a tremendous amount of help here my last semester, so I am back . I have a pt and our care plan is of course supposed to be more involved I suppose then last semesters.. I just wanted to know if these diagnosis look ok... I am not sure if you are allowed to include lab numbers in your diagnosis or not.. Here is some info about my client that I thought would be relevent. 80 yr old with pneumonia her h&h are low her bun and creatnine are high (still trying to figure out what that means to her system as a whole.. know its the kidneys.. thinking a volume prob?) umm and everything else is ok cept her glucose is 137.. Can someone just let me know if these diagnosis make sense... I am pretty confident they do.. here they are in no particular order

    ineffective airway clearance rt/ retained secretions AEB nonproductive cough
    impaired gas exchange r/t ventilation-perfusion imbalance AEB tachycadia
    deficient fluid volume r/t active fluid volume loss AEB diarrhea
    acute pain r/t inflammation of lung tissue AEB pt's report of pain at a 6 on a scale of 1-10
    deficient knowledge of pneumonia and treatment r/t lack of information AEB pt states "this is the first time I have had pneumonia"
    risf for infection r/t hospitalization.
    risk for injury r/t altered clotting factors (she is on coumadin)
    imbalance nutrition : less then body requirements r/t illness AEB pts consumption of less then 50% of her meals
    (that one I am not sure about... dont know if I can blame it on the illness.. she just told me she doesnt like hospital food)
    hyperthermia r/t illness ARB increase in body temp above normal range
    Ineffective cardiopulmonary tissue perfusion r/t hemoglobin in blood AEB dyspnea and low hemoglobin level of 9.3.

    I am sure there are many more that I can use. We need to write 10 and choose 5 to write up. I had a patient last semester with Pneumonia as well that I had to write up 3 on.. so I am trying to expand my horizions and use totally different diagnosis so as not to right up the same ones. Any thoughts on these? good..? bad?.... any help would be appreciated! :heartbeat

    Thanks everyone!