Does this nursing diagnosis sound ok for my care plan???

[ggspears]

For a patient who has COPD!!

impaired gas exchange r/t ventilation-perfusion inequality secondary to smoking two packs of cigarettes faithfully for over 40 years aeb productive cough and dyspnea decrease O2 levels without Oxygen at 5L gasping and squirming for air.

[HM2VikingRN, RN]

I would try and simplify it......

Anxiety r/t dyspnea AEB.........?

Do you have a diagnostic book?

[ggspears]

Yeah I have Ackley which is awesome, the example they give is Impaired gas exchange r/t ventilation-perfusion inequality. I just wanted to add something else to it. And ideas?

[Valerie Salva, BSN, RN]

I don't think "gasping and squirming" are good.

How about relating one of the primary symptoms of COPD?

I.E. AEB ........shortness of ______ . Is the pt SOB all of the time or just when exerting himself?

As for the productive cough- is it acute or chronic? I would relate it to the COPD- Is COPD an acute or chronic disease?

If it is all of the time, how would you word that?

[nursejllrn]

maybe "secondary to tobacco abuse x 40 years" (Sounds a little less judgemental)

[PsychNurseWannaBe, BSN, RN]

maybe "secondary to tobacco abuse x 40 years" (Sounds a little less judgemental)

I kinda thought the same thing... the "faithfully" part got me.

[Daytonite, BSN, RN]

i think that perhaps you have the wrong related factor for your 3-part diagnostic statement. a patient with copd has problems with gas exchange because of alveolar-capillary membrane changes (the pathophysiology is such that the alveoli are breaking down making the available membrane for gas exchange less than in the normal person). with ventilation-perfusion inequality, or imbalance, you have a situation where you have normal anatomy in the lung (do you really have that with

copd?), but the lungs are blocked with debris and exudate in the alveoli. this occurs in conditions like pneumonia and cancer where there are infiltrates that collect and block these structures making gas exchange impossible. unless you have evidence of an x-ray showing an infiltrate then this patient's gas exchange problems are due to alveolar changes, not gunk collecting down in the lungs. so, your diagnostic statement should read: impaired gas exchange r/t alveolar-capillary membrane changes secondary to copd aeb dyspnea, decreased o2 levels on room air, gasping and squirming for air without supplemental oxygen. i would also suggest that you include a set of abgs on room air if you have them in place of "decreased o2 levels on room air" and describe the type of respiratory effort being made (pursed-lip breathing, use of accessory muscles when breathing, leaning forward when breathing, audible wheezing) instead of using "gasping and squirming".

now, you have a second problem going on and that is airway obstruction (i'm talking about the bronchi) due to the accumulation of secretions and that is evident by all the coughing. the proper nursing diagnosis to use for that is ineffective airway clearance r/t history of smoking, copd, and excessive mucous aeb coughing. is this cough productive? then say so. have you seen what the sputum looks like? color (white, yellow, gray, blood-tinged), consistency (frothy, thick, copious in amount--can be up to one cup a day), and any odor (foul smell)?

please read the nanda information in your ackley/ladwig nursing diagnosis book for these two diagnoses. it is right under the heading of each to see the definitions, defining characteristics and related factors. always read up on the pathophysiology of the medical disease that the patient has--in this case copd, to get the correct related factors (etiologies) on some of your nursing diagnoses.