Figuring out right diagnosis for Pleural effusion

Nursing Students Student Assist

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This was my patient's diagnosis this week. I know that it could be impaired gas exchange or ineffective breathing pattern due to the fluid build up making it difficult for the lungs to expand. But I can't decide which one would be more appropriate in my patient's case. (I used ineffective breathing pattern last week so can't use it again, but still wondering which is more important) Her O2 was great, RR was 16-20, but HR was up around 111. I think this was due to her low BP. Anyways, she had a CT that drained about 50ml during my shift, but had drained about 300ml since insertion. She was on room air. The only thing is that she was having trouble taking deep breaths, because of the chest tube and some chest congestion. She had a productive cough and was having difficulty coughing anything up. She also had nasal congestion from allergies. I honestly think she was getting a sinus infection, because she complained of pressure around her eyes and stopped up ears. She did have crackles in her LLL. Oh and ABGs were normal.

After caring for her I really thought my ND should be ineffective airway clearance, but I'm not sure if that should come before the others. Can somebody help me understand which one would be more important? I don't feel like I can do as much for impaired gas exchange as I could for ineffective airway clearance. I know I could assess, monitor, and make sure she participates in her treatment, but I would do those things anyway. However, I'm thinking that the simple act of assessing and monitoring could be more important to prevent hypoxia. At the same time I think if she can't clear the mucus she could get an infection that could worsen her oxygen status.

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Specializes in Public Health.

Esme and grntea would probably tell you to diagnose off of assessment NOT medical diagnosis. Also always use ABCs

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Well I am. My instructor said impaired gas exchange and I understand why. I just want to include interventions for the other as well.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You keep choosing your diagnosis and then attempt to fit your patient into it.

You are working backwards and that is what makes it difficult for you. What did the CXR show? What is a pleural effusion? "Crackles were heard..what does that indicate for this patient? What should YOU as this patients nurse want to do for them? How would you need to organize your day to care for this patient...what is important for this patient and what is important to look for? What do you need to do for this patient with the chest tube to improve her lung expansion? Since she needs to cough and can't do that effectively what about the chest tube can you help with so the patient will cough harder? IS she having pain? Is pain elevating this patient heart rate? IS she getting breathing treatments?

What does she need? Like GrnTea says.....

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__." https://allnurses.com/nursing-student-assistance/why-do-patients-856423.html#post7529786

What care plan book do you use again? You do have the NANDA I right?

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Not impaired gas exchange IF ABGs are normal. By definition. How can your instructor think about impaired gas exchange when ABGs are normal? You're talking GAS exchange:) . ABGs are the gold standard for measuring GAS EXCHANGE. You can pull out your NANDA-I 2012-2014 and look on page 214. Read the definition (it's "excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane") and see the defining characteristics for the diagnosis. Do these apply to this person? How would you know?

OTOH, you should be thinking about ineffective breathing pattern (page 233); you should definitely take a look at that. Hint: I know that in many settings, a resp rate of 20 is considered "normal." OK. Right now, take out your watch with a second hand, the one you use to take VS, and breathe every three seconds for two full minutes. No cheating. How does that feel? Is that your normal respiratory rate? What would have to be going on for you to breathe that fast? Are any of those "defining characteristics" included in that? Does your patient have any of those? What? Why?

You DO have that NANDA-I 2012-2014? (free 2-day delivery from Amazon for students) If you don't you are not able to make good decisions about nursing diagnoses. A list of sexy-sounding diagnoses without knowledge of the required defining characteristics and related factors is not useful. (Your faculty has helpfully, though unwittingly, illustrated precisely why this is true.)

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Not impaired gas exchange IF ABGs are normal. By definition. How can your instructor think about impaired gas exchange when ABGs are normal? You're talking GAS exchange:) . ABGs are the gold standard for measuring GAS EXCHANGE. You can pull out your NANDA-I 2012-2014 and look on page 214. Read the definition (it's "excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane") and see the defining characteristics for the diagnosis. Do these apply to this person? How would you know?

OTOH, you should be thinking about ineffective breathing pattern (page 233); you should definitely take a look at that. Hint: I know that in many settings, a resp rate of 20 is considered "normal." OK. Right now, take out your watch with a second hand, the one you use to take VS, and breathe every three seconds for two full minutes. No cheating. How does that feel? Is that your normal respiratory rate? What would have to be going on for you to breathe that fast? Are any of those "defining characteristics" included in that? Does your patient have any of those? What? Why?

You DO have that NANDA-I 2012-2014? (free 2-day delivery from Amazon for students) If you don't you are not able to make good decisions about nursing diagnoses. A list of sexy-sounding diagnoses without knowledge of the required defining characteristics and related factors is not useful. (Your faculty has helpfully, though unwittingly, illustrated precisely why this is true.)

Ok. Thank you. Ineffective breathing pattern definitely makes more sense. I guess impaired gas exchange is more of a risk for. Maybe that's what my instructor meant. Not sure though.

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No, people can have actual impaired gas exchange, if I understand you correctly. Or maybe your instructor thanks the pt is at risk for impaired gas exchange due to something else you haven't mentioned. Remember, that happens at the alveolar level. What would affect that and put the patient at risk for poor gas exchange in the alveoli?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

This is the same patient that had all that surgery....spleenectomy, GB, TAH, hiatal hernia repair there is another disease process here....like cancer. There is something that you didn't find in the chart that connects all of this.

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I gave her my guess in the other thread. :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

when I said you...I meant the OP....LOLOLOL

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