Nees help with Pneumothorax dx plz!

You mention that you "need more diagnoses". What have you diagnosed so far? I went through the data you posted and this was the abnormal data I came up with that I would use to determine the patient's nursing problems:

• decreased lung sounds bilaterally
• breathing is shallow and rapid
• unable make incentive spirometer move
• BUN was 5
• pt reported diarrhea yesterday
• voids in bedside commode
• gait is unsteady
• 71 yrs old
• agitated as she is in pain
• an surgical wound somewhere?

Every nursing diagnosis has a definition, related factors (causes) and defining characteristics (signs and symptoms). These can be found in a nursing diagnosis reference book, a currently published care plan book or the appendix of recent editions of Taber's Cyclopedic Medical Dictionary. You need to match the above symptoms with likely nursing diagnoses. Part of diagnosing also includes looking up the pathophysiology as well as the signs, symptoms and complications of the patient's medical conditions (pneumothorax and MRSA). The chest tube and pleura-evac are medical treatments that, as nurses, we are often responsible for carrying out so we need to know how they are to be done, any complications connected with them and where they fit in with the nursing diagnoses and nursing care.

Can I put that under knowledge deficit or ineffective breathing pattern?

Yes, but how is it that you came to diagnose these? I found no evidence, or proof, of Deficient Knowledge, specify in the data that you posted. The fact that you taught the patient to use an incentive spirometer is not evidence that she didn't know how to use it to begin with. When writing a care plan everything must follow a step-by-step rational approach that pretty much tells a story of what has happened. First, assess. Second, state the problem (diagnose). Third, list strategies to do something about the problem (goals and nursing interventions).