care plan: acute/chronic pain? ineffective breathing pattern/impaired gas exchange?

[AshleyAnn123]

Hello, I am a 2nd year nursing student who is doing a care plan that includes three priority nursing diagnoses, I love doing care plans, put this one has got me stumped! right now, my priorities are:

1. Ineffective breathing pattern (or impaired gas exchange?)

2. chronic pain (or acute pain?)

3. Risk for injury.

I have 2 questions:

1st, which is a more suitable 2nd Dx for this pt. Acute pain, or Chronic pain? (I'm leaning towards chronic, but my instructor suggested acute, though we didn't get the chance to swap insight on the matter)

2nd, which is a more suitable Priority Dx for this pt. Ineffective breathing pattern or impaired gas exchange? (these seem to be 2 aspects of the same problem, Ineffective breathing pattern seems to be causing her impaired gas exchange, not having a lot of experience, this one is tough for me to differentiate in regards to my pt.)

My date of care was just one day (9-28-10)

here is a bit about my pt.

MD hx:

anemia (history of bleeding-anal, lady partsl)

DM II (a1c 5.6%)

morbid obesity-pickwickian appearance (409lbs)

CAD (stent placement)

conestive heart failure ( presumably diastolic with a relatively perserved normal systolic ejaculation fracture)

sleep apnea (on bipap)

hypothyroidism

hemidiaphragm paralysis ®

depression

anxiety

GERD

osteoarthritis

maniscal tear

chronic low back pain

migrane headaches

vertigo

RLS

hypertension, hyperlipidemia

menemetrorrhagia

incontinent (urge)

chronic constipation

Diagnostic testing

creatnine was high and rising 1.06 mg/dL

RBC low and lowering 3.38 m/uL

HGB low and lowering

lymphocytes low and lowering

arterial pco2 is high and rising, 53

along with many other variations

anemia??

47, F. presented to ER (via ambulance) on 9-25-10 c/o acute SOB, unable to speak r/t dyspnea; distressed with labored breathing. (no c/o pain documented) pt. was also admitted with a cold.

she ended up on med-surg where I took care of her on 9-28. before discharge home on 9-29.

her V/S were WNL, and her o2sat is 99% on Bipap, and O2 4L/mi

her pain level was 9/10 reduced to 6/10 40 min. after admin. oxy.

she complained of general, lower back, knee, lung, and chest pain that occurred with movement. she stated that it was constant, sharp, dull, stabbing and achey.

unfortunately, i did not ask her what was new and what was old pain -lesson learned...

patient expeiriences SOB immediately upon transfers or ambulation

SOB when talking

CMS WNL

any suggestions on my priority nursing Dx? should I consider a new one entirely? thank you all for your help!

[klone, MSN, RN]

normal systolic ejaculation fracture

This made me giggle.

I think you meant to say "ejection fraction"

An ejaculation fracture is something ALTOGETHER different!

[netglow, ASN, RN]

Sorry OP, but that was really funny.

[netglow, ASN, RN]

Look up the details on the airway related DX... Hint would be what you found with lung assessment acutely, then you have your physical limitations on normal function underlying.

[Esme12, ASN, BSN, RN]

This made me giggle.

I think you meant to say "ejection fraction"

An ejaculation fracture is something ALTOGETHER different!

:hhmth:I fell out of my chair laughing! Laughing with you OP not at you!