Having Trouble

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Specializes in Hemodialysis, Home Health.

I have to come up with three Diagnosis for my patient I had in clinicals last week and do careplans for each. I have a few ideas but I am having a hard time coming up with my related to's ( I always have problems with this). My patient was having severe chest pain and later on that day the doctors told him that he had an MI the night before(they think it was the night before). My three diagnosis I was going to use were, Acute Pain, Inneffective Tissue Perfusion, and Activity Intolerance. My teacher suggested using Shortness of Breath as a related to for the pain, but I am confused about that? We arent allowed to use medical diagnosis as the related to's. Also you cant use acute pain related to chest pain, that doesnt sound right at all. I am just so confused right now normally I am good at this but I am just drawing a blank. If anyone wants to help a poor nursing student I would greatly appreciate it! :chair:

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Specializes in home health, neuro, palliative care.

How about:

acute pain r/t impaired blood flow to heart muscle

~Mel'

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Specializes in Telemetry & Obs.

The pain resulting from a MI is related to ischemia or lack of oxygen to the heart muscle caused by the impaired blood flow.

Do you have a good care plan book?? They're invaluable!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

the items that follow the words "related to" in your diagnostic statements refer to what is the cause of the nursing diagnosis. so, for the patient's pain in his chest you need to ask yourself, "what is the underlying cause of the pain in his chest?" to have an understanding of this, you need to re-familiarize yourself with the pathophysiology of a myocardial infarction and ask yourself what is going on in the heart that is leading to the pain the patient is having? because of a blood clot or a build up of plaques one of the major arteries of the heart has become occluded. when that happens, the portions of the heart muscle fed by that artery and it's tributaries are deprived of oxygen and nutrients. the pain is due to the oxygen deprivation and resulting tissue ischemia. you also need to look at the symptoms of myocardial infarction

  • persistent, crushing substernal chest pain that may or may not radiate
  • cool extremities
  • perspiration
  • anxiety
  • restlessness
  • shortness of breath/crackles
  • fatigue and weakness
  • nausea and vomiting
  • jugular vein distension
  • presence of s3 and s4 heart sounds
  • reduced urine output

and myocardial ischemia, which you now know the patient to have:

  • chest discomfort
  • shortness of breath
  • fatigue
  • palpitations
  • dizziness
  • peripheral edema

does your patient have any of these symptoms? if so, then you are perfectly able to use those symptoms as "related to" factors in your nursing diagnostic statements. the doctor is also allowed to use them to describe his medical diagnosis. symptoms are items of factual information.

to get back to your question about your nursing diagnoses. . .your patient's chest pain is due to the lack of oxygen to his heart, so you should write your nursing diagnosis like this:

acute pain r/t cardiac tissue ischemia aeb chest pain [and also describe any radiation as well]

the nursing diagnosis of ineffective tissue perfusion would normally be used where oxygen is unable to nourish the tissues at the capillary level and the nurse can perform nursing interventions. only emergency medical intervention is going to restore capillary level tissue perfusion in a patient with an myocardial infarction if it can be done in time to prevent damage from occurring. once the infarct has occurred and time has elapsed as in the case of your patient, the damage is done and cannot be reversed. ineffective tissue perfusion is not a nursing diagnosis that is appropriate to use for a patient who has already had a myocardial infarction as in the case of your patient. he has had his mi and the damage is done. a part of his heart muscle has died and is not going to regenerate. as a result of that he will have other symptoms that will be handled more efficiently and appropriately by other nursing diagnoses.

may i suggest that other appropriate nursing diagnoses to use for this patient might be:

  • decreased cardiac output r/t damage to ventricle of heart or cardiac ischemia
  • ineffective breathing pattern r/t compromised cardiopulmonary function aeb shortness of breath
  • anxiety r/t shortness of breath, fear of death, and/or lifestyle changes

here are two website where you can get medical diagnosis information about mi's and cardiac ischemia.

if you haven't already read them, you should also read the information on these threads that have to do with the nursing process and care plan writing:

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Specializes in Critical Care, Cardiothoracics, VADs.

I never answer careplan questions anymore, since Daytonite always does it a hundred times better! Sounds like good advice :)

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Specializes in Hemodialysis, Home Health.

Thank you to all of you who replied to this post! I finally got them done today and I so appreciate your help! I hate careplans! But I guess it just takes time to get used to them. Just thanking the Good Lord that this semester is almost OVER! Yee Haww!~

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Specializes in LTC.

Glad you were able to finish them! I hated careplanning when I was in school, LOL.

Don't forget your psych/social diagnoses, such as depression, anxiety, coping, etc. You should almost always be able to come up with at least one, and they can also apply to family members. Many patients who go through something that lands them in the hospital suffer emotional and family strain.

Daytonite, I always enjoy reading your replies. They are SO thoughtful and organized. I know you've worked in management, but do you teach as well? The field needs more like you.

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