Activity Intoleranc- Priority Diagnosis?

hypocaffeinemia, BSN, RN · Dec 7, 2008

While your patient meets one of the related factors for Impaired Gas Exchange (reduced O2 carry capacity of blood), does he might any of it's defining characteristics?

If he doesn't have one or more of:

Confusion
Somnolence
Restlessness
Irritability
Inability to move secretions
Hypercapnia
Hypoxia

...Impaired Gas Exchange would be an inappropriate diagnosis. If he meets none of the above criteria, at best he'd merely be a Risk for Impaired Gas Exchange.

You have to look at what problems your patient has. Just because your patient is anemic doesn't necessarily mean they have impaired gas exchange or impaired tissue perfusion or even activity intolerance. Those are all definitely possible, but as Daytonite is sure to tell you, review the steps of nursing: Assessment comes first.

I know this is a test question and not a real patient, which makes things difficult. Look at the information given. She won't tell you the patient has activity intolerance, she'll say something like "dyspnea upon mild exertion" which will clue you in to the activity intolerance.

If she just asks you, "Which diagnosis is top priority for a patient with iron deficiency anemia?" In my mind, that's a poor test question as not enough info is given. If the patient is asymptomatic, for instance, their top priority may be their imbalanced nutrition.

Daytonite, BSN, RN · Dec 7, 2008

we are currently in pediatrics, and i have a test on monday on hematology. a teacher is confusing me regarding the nursing diagnosis of activity intolerance. she insists that it is the priority nursing diagnosis for anemia, yes, even for iron def anemia. her reasoning is that activity intolerance is related to the oxygenation needs of a patient. i understand that, but wouldn't impaired gas exchange be a better diagnosis?

no, it is more appropriate to use

activity intolerance

rather than

impaired gas exchange

. the reason lies in the definitions and defining characteristics (signs and symptoms) of these two diagnoses. if you refer to the nanda taxonomy you will find:

activity intolerance
- definition:
  insufficient physiological or psychological energy to endure or complete required or desired daily activities
- defining characteristics: abnormal blood pressure response to activity, abnormal heart rate response to activity, electrocardiographic changes reflecting arrhythmias, electrocardiographic changes reflecting ischemia, exertional discomfort, exertional dyspnea, verbal report of fatigue, verbal report of weakness
- page 3,
  nanda-i nursing diagnoses: definitions & classification 2007-2008
- http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=01
- activity intolerance
[*]
impaired gas exchange
- definition:
  excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane
- defining characteristics: abnormal arterial blood gasses, abnormal arterial ph, abnormal breathing (e.g., rate, rhythm, depth), abnormal skin color (e.g., pale, dusky), confusion, cyanosis (in neonates), decreased carbon dioxide, diaphoresis, dyspnea, headache upon awakening, hypercapnia, hypercarbia, hypoxemia, hypoxia, irritability, nasal flaring, restlessness, somnolence, tachycardia, visual disturbances
- page 94,
  nanda-i nursing diagnoses: definitions & classification 2007-2008
- http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=23
- impaired gas exchange

while both diagnoses deal with issues of oxygenation,

impaired gas exchange

is clearly talking about what happens at the cellular level where oxygen enters the body, the only place that it can enter the body--the alveoli of the lungs. that's not what happens with anemia. with anemia, you have an oxygenation problem because of a fault with the hemoglobin carrying capacity of the rbcs. that has nothing to do with impaired gas exchange in the alveoli. as long as the alveoli are not obstructed in any way, the lungs and alveoli are doing their job. the result of anemia is the patient is fatigued and has difficulty breathing when doing activity--

not

problems exchanging oxygen and carbon dioxide in the alveoli. that's

activity intolerance

and

not

impaired gas exchange.

keep in mind that nursing diagnoses are the patient's

responses

to their medical conditions. the patient's

response

to anemia, whether it is blood loss anemia or iron deficiency anemia, is going to be difficulty

enduring or completing required or desired daily activities

not difficulty

in oxygenation and/or carbon dioxide elimination

at the alveolar-capillary membrane

.

the patient's alveolar-capillary membranes will be working just fine unless he has a respiratory disease like one of the copds or pneumonia.

i constantly remind students that nursing diagnoses are nothing more than labels, or names, for the real nursing problems which is very well described by reading the definition and defining characteristics. this is why you should have a nursing diagnosis reference in order to look beyond the label so you can refer to this kind of information. it puts it in perspective for you.

the whole class is just frustrated by her. the same instructor decided that picking risk for aspiration for a patient with parkinson is wrong, and the priority diagnoses should be impaired thought processes.

i'm truly not meaning to be mean here, but you are talking about priority diagnoses. a diagnosis is identification of a problem. "risk for" diagnoses are no problems at all. they are anticipated problems that don't even exist.

http://www.merck.com/mmpe/sec16/ch221/ch221g.html

symptoms of parkinson's includes mood changes and some of the side effects of the medications used to treat this disease can produce hallucinations and delirium.

have you seen michael j. fox lately? would you say he looks normal with his parkinson's? don't misunderstand me because i'm not being mean. he has problems because of his disease and he is coping very well with them but he has had to make adjustments in his daily life. i saw a tv program (probably on etv) about him and his co-stars on

spin city

commented on how his behavior had changed and how puzzled they were about his crankiness as well as how they had to wait around for "him" to decide to make an appearance so they could shoot scenes. they felt he was getting rather egocentric and he had never been like that before. this was because he was having problems with his parkinson's which he had been keeping secret from them. this is a disease of the brain and he was very concerned about the side effects any medications he took would have on his memory and his behavior.

disturbed thought processes

can be caused by organic brain changes (as in parkinson's disease). this is one of the related factors for this diagnosis. the defining characteristics are cognitive dissonance (this is saying one thing and doing another), distractibility, egocentricity (something michael j. fox's colleagues were accusing him of), hypervigilance, hypovigilance, inaccurate interpretation of environment, inappropriate thinking, memory deficit, inability to meet basic needs, inappropriate use of defense mechanisms, alteration in social participation, obsessive thinking, decreased problem solving ability.

we could say mr. fox has

disturbed thought processes r/t organic brain changes secondary to parkinson's disease aeb alteration in social participation and development of some egocentricity around co-workers.

jgg765 · Mar 16, 2010

A have someone with Warm Autoimmune Hemolytic Anemia.

Just wanted to thank you folks for answering this question I feel people spend a lot of time answering questions and are not appreciated I really do appreciate it.

Thanks!!

Jonathan.

:yeah:

Zookeeper44, RN · Mar 16, 2010

Activity Intolerance is a priority dx due to its being a pt. safety issue, IMO.

Agreeing that anemia is not the same as impaired gas exchange so that would not be an appropriate dx.