actually, the dvts are not so much a cause of inadequate tissue perfusion, are they? how would venous clots slow or impair tissue perfusion, which is generally thought of as an arterial problem?
so for the dvt, think about what that puts him at risk for, both the condition and the meds they'll put him on for it; think about how you would watch for complications, teach him about his new med, and make his environment safe with it.
now. let's break this down:
"ineffective peripheral tissue perfusion r/t paraplegia and second hand smoke exposure aeb hct 31.6l, hgb 10.9 aptt-heparin: 57.1. absent pedal pulses only heard w/ doppler and were weak b/l. puffy legs w/ +2 edema b/l, cap refill >3 sec b/l. pt. not unable to move from the waist down."
is ineffective tissue perfusion caused by paraplegia? caused by 2ndhand smoke? not so much, i don't think-- marginal in the smoke, and temporary. does a low h/h and clotting study tell you how the paraplegia and the 2ndhand smoke cause problems? not really, either. at least not first-line problems.
now, though, if you rethink this, you're on to something with ineffective tissue perfusion, and i'd advise you to carry it a little further.
think about this: he has low oxygen-carrying capacity even if he has decent spo2 (low levels of red cells and hemoglobin to carry oxygen, and spo2 is only a percentage of the red cells carrying o2, not an absolute measure of how much oxygen is being carried).
did you know that paraplegia increases risk of cardiovascular disease? he has poor peripheral pulses, and his capillary fill is slow. he's edematous mostly because he has no venous pumping going on since his muscles don't work, unless he has an additional diagnosis of chf, which will make it worse.
so if a paraplegic has lousy tissue perfusion and no sensation, what does that put him at risk for? how would you assess for it? what nursing measures would you put into place to assess him and prevent those complications? how would you teach him about this, how to prevent it, and what to do if it happens?