i am a new nursing student and new to this site. i am working on my first case study, and i am having a hard time deciding on the diagnosis. i know i am close, but i am such a perfectionist that my uncetainty is driving me nuts. i can not make a decision unless i am absolutely sure. i have spent countless hours on this trying to decide, so needless to say my time-managment is not going well. i will take any help i can get. the case is as follows:
"i can't breathe." morrie gasped for breath. "help me."morrie looked up at you, his nurse, with eyes filled with fear. he raised thehead of the bed farther with the control and continued to gasp for breath. youcould feel your own anxiety increasing; it felt like morrie's anxiety wascontagious. you pushed the overbed table so morrie could lean forward on it,sat on his bed, and worked with him to do pursed lip breathing and slow hisbreathing. you have given him all the medications that he could have. and youprayed he would get better.
morrie has chronic obstructive pulmonary disease (copd).he has been suffering for
5 years and is frequently a client on the respiratorynursing unit. he stopped smoking once diagnosed, but unfortunately still has significantlung disease. his vital signs are: 180/92-100.2-116, 28. his lungsounds are wheezing, with loud crackles throughout. the oxygensaturation is 84. he has oxygen per venture mask. his toes and fingersare cyanotic, as well as his oral mucous membranes.
based on this information i grouped the significant symtoms and with the help of my nursing diagnosis handbook, came up with the possible diagnosises of ineffective airway clearance, imparied gas exchange, and ineffective breathing patterns. after that i am asked to give a complete diagnosis with the "related to" and "aeb". i can not decide whether to use impaired gas exchange r/t ventilation-perfusioninequality aeb abnormal breathing, cyanosis, tachycardia, hypoxemia, anddyspnea, or ineffective airway clearance r/t hyperplasia of the bronchial walls and asthma aeb adventitous breath sounds, cyanosis, and dyspnea.
i realize that both might apply to the patient, but i need to pick the one that is most accurate/ more serious. which diagnosis is it most likely to be with the senerio?
@dixielee, you should be glad you don't have to deal with this! I have been in a hospital setting for 15 years, and I know how things are done on a floor. So when I get a scenario like that in nursing school, and I am told "okay -- you are the only nurse in the known hemisphere, and you have to deal with all of this. What would you do"? Well in real life, I would never be alone, and also, I would follow the physician orders that they so thoughtfully supply. Yes, I need to learn to assess, yes I need to learn critical thinking, but you are right. This is why nursing school makes me crazy!
ETA that I agree. Grn Tea is my hero too. I have learned so much from those posts!
Last edit by FineAgain on May 22, '12
: Reason: So that I could bow to Grn Tea