Some background info: my patient was admitted with pneumonia, has a history of COPD, CHF, HTN, former smoker. She has told me that at home where she lives with her daughter she sits in a chair very similar to the one she was sitting in in the hospital and that's about all she likes to do all day. She is O2 dependent (she was on 4 L at the hospital).
Throughout my clinical shift, she got very tired easily. Such as, during AM care (she was sitting down in her recliner chair, she did not want to be in the bed or anywhere else), as I was even washing/wiping her legs, she felt tired. And then my professor wanted me to assess her pressure ulcer on her L & R buttocks, but she refused to stand up/move from her chair at all. I couldn't force her, so my professor really talked her into it. We had the patient stand up as she chose to hold on to the side of her bed while we examined her buttocks, but not even 15 seconds on she wanted to sit down and stop the whole process.
If anyone needs anymore info. I will provide what I can!
I have 2 other nursing diagnoses in mind already that are priority before this one, but based on this information would Activity Intolerance be a good 3rd diagnoses? Like for example:
Activity intolerance related to sedentary lifestyle (?) manifested by patient reports feeling weak when ______ (i'm not quite sure what to say/how to word this part)
Or would it be r/t to her COPD/pneumonia? See this is where I confuse myself. Because for my 2nd diagnoses on my care plan I want to put Impaired skin integrity r/t ___ ? (I want to put sedentary lifestyle here too) manifested by pressure ulcer sores on R & L buttocks; because she does not like to move/get up, even when me & my professor both educated her on importance she just said "yes i know" and all that.
Yes, I have a much better idea now thank you. I especially found it very helpful with the
A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. "
That really put it into perspective.
Here's what I have so far:
Impaired skin integrity related to limited mobility (when we tried to ask her to stand up or move to her bed for assessment (her activity order is OOB to chair with assist) she refused. When educated by me & my professor, she insists she knows and wanted to stick with her ways) manifested by pressure ulcer sores on right & left buttocks
Activity intolerance related to sedentary lifestyle manifested by patient reports fatigue & feeling weak when asked to stand
My dad had COPD and died of emphysema in 2004. In advanced COPD just about EVERYTHING will cause the patient to be SOB. Becoming SOB is a scary feeling for patients and I think your patient is afraid of bringing about shortness of breath (by leaving the chair), it's not that she is purposely being stubborn or set in her ways. I understand that the skin integrity on her bottom needs checked, but couldn't it be done the next time she is being moved to bed? I wouldn't ask her to stand only to check her skin, I would wait and assess her skin when she is moved. Just a thought :) The nursing dx I would use include (NANDA) Activity intolerance r/t imbalance oxygen supply and demand. Impaired gas exchange r/t ventilation-perfusion inequality. Anxiety r/t breathlessness. Impaired skin integrity r/t physical immobilization. Good luck to you in your studies :)
Esme12 and GrnTea are the nursing dx queens, and it looks like you've gotten some great info there. I just wanted to point out that COPD and CHF can cause *severe* activity intolerances, and in the later stages they have sx at rest and often don't want to move around much. It's not about being lazy or set in their ways...it's about feeling rotten when they try to move. This poor woman has *both* COPD and CHF.
"r/t sedentary lifestyle" seems to imply that you're assessing the cause of her deconditioning to the unwise choice to sit on her rump all day, when in fact there are pathophysiological reasons for being compelled to sit on her rump all day.
Thank you. :) I have changed it now! Thank you all for putting it into perspective for me. At first I was scared to post my diagnoses but it's definitely worth it getting help from everyone here!
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you. :) I have changed it now! Thank you all for putting it into perspective for me. At first I was scared to post my diagnoses but it's definitely worth it getting help from everyone here!
((HUGS)) don't be afraid here...although I was sick I am back and I am here every day
This poor woman has *both* COPD and CHF.
hkqueenx3
17 Posts
Yeah sorry haha, slipped my mind. Ok, thank you!