A Fib and Pneumonia

[BSNStudent2010]

My teachers are trying something new this semester. We have to turn our care plans into concept maps to show how everything correlates. The patient I am doing mine on this week has both A Fib and Pneumonia. He actually came into the hospital with A Fib and acquired pneumonia in the hospital. He also has diabetes. I have a really hard time trying to tie all these pathos together. I have read on the internet that pneumonia can cause A fib, but I did not fully understand the concept. Also, this patient had diabetes, which significantly complicates things. How does diabetes increase your risk for pneumonia and A fib? And also how do A fib and pneumonia correlate?

Also, I have to come up with 6 nursing diagnosis.

These are what I have thought of so far...any thoughts would be great!

1. Impaired gas exchange

2. Ineffective airway clearance

3. Decreased cardiac output

4. Impaired tissue perfusion

5. Activity Intolerance

I just can't think of a sixth one!! Also, just in everybody's opinion, do you think I should target my interventions toward each individual medical diagnosis? OR should I correlate the A Fib, diabetes, and pneumonia into each of the nursing diagnosis I chose and intervene for all the medical diagnosis? I hope what I am saying makes since and any help would be greatly appreciated!! Thanks so much!

[Daytonite, BSN, RN]

i have read on the internet that pneumonia can cause a fib, but i did not fully understand the concept.

this thread has the pathophysiology of atrial fib:

https://allnurses.com/general-nursing-student/a-fib-281871.html

. and these are its causes:

http://www.fpnotebook.com/cv/ekg/atrlfbrltncs.htm

. atrial fib tends to occur in respiratory conditions that involve congestion of the pulmonary circulation as in chf, pulmonary embolisms, or the copds. pneumonia qualifies because the lungs have gotten congested with exudates as a result of the infection so the circulation to the lungs is struggling for every blood cell to get through the pulmonary network. the heart and lungs are bound together; what happens to one affects the other. atrial fib is usually the first arrhythmia to occur of the arrhythmias.

how does diabetes increase your risk for pneumonia and a fib?

diabetics are prone to developing infections and longer healing times especially if their blood sugar levels are not kept in control. diabetes doesn't cause atrial fib, but people with diabetes do have a high complication rate for coronary artery disease.

also, i have to come up with 6 nursing diagnosis.

diagnoses are based upon abnormal data that was collected during the assessment of the patient. that data will be put on your concept map as well. since you have provided none of that, i can't comment as to whether any of your diagnoses are appropriate or not. nursing diagnoses are not related to the patient's medical diagnoses other than they may incorporate some of the same signs and symptoms as the medical diagnoses. nursing diagnoses reflect the patient's

response

to their medical diseases.

also, just in everybody's opinion, do you think i should target my interventions toward each individual medical diagnosis?

nursing interventions, like medical interventions, target the signs and symptoms (evidence) that you have that support and prove why the patient has a nursing diagnosis (nursing problem). for example, the first diagnosis you list is

impaired gas exchange

. it is because the patient's alveoli are filled with exudate so the exchange of oxygen and carbon dioxide is compromised. the evidence that you have to support using this diagnosis should be things such as a set of abnormal blood gases or pulse ox showing the patient has some abnormal o2 levels, sob, and perhaps some tachycardia. your nursing interventions will target these symptoms. you will be giving the patient o2, teaching them the importance of keeping the o2 on, showing them ways to position themselves to ease their breathing, and providing periods of rest. that is what we nurses do.

or should i correlate the a fib, diabetes, and pneumonia into each of the nursing diagnosis i chose and intervene for all the medical diagnosis?

treat the

nursing problem

with

nursing interventions

.

for nursing concept map information and examples of nursing concept maps that you can look at, see

https://allnurses.com/nursing-student-assistance/care-maps-225330.html - care maps

[Daytonite, BSN, RN]

this is a better sequence. however, these are all pretty much addressing the same problems.

1. decreased cardiac output - this is always sequenced before respiratory diagnoses
   
2. impaired gas exchange
   
3. ineffective airway clearance
   
4. impaired tissue perfusion - the organ whose tissue perfusion is impaired should be identified in the title; if it is the heart, it is covered by decreased cardiac output; if it is the lung identify it as "ineffective tissue perfusion, cardiopulmonary".
   
5. activity intolerance - elevated heart rate, respiratory rate, b/p and fatigue with activity can be covered with impaired gas exchange.