care plan help, please!

[mom2emcal]

Hi -

i just met with my patient today and now need to get my 3 nursing Dx's. My patient is 85 y.o male had SOB so his dr sent him for ct scan . Turns out they see a mass on the scan so she told him to go to er to be admitted. So they did a bronchosopy yesterday and now he is just waiting to hear from the oncologist. he is on albuterol and salmetrol but he is not on O2 and his pulse ox is good. He is a fall risk (walks with cane ) so i can use that one. also he is scared of what his treatment will be for the cancer. any ideas of what other dx's i can use? i thought i should focus on his breathing but ohe is not really having a lot of resp. distress. should i use impaired gas exchange?

[DMSEVO8]

Breathing pattern ineffective

[lvnlrn]

I think the fall risk would be prioritized as 3rd, with a care plan regarding his powerlessness 2nd, and breathing being 1st (good old Maslow).

I wouldn't use impaired gas exchange. The NANDA definition is "Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane". With his oxygen sats being good, this wouldn't really fit. My instructors actually went as far to tell us they hate this dx! I think you're on the right track though...

I agree with DMSEVO8 about using ineffective breathing pattern. The NANDA definition for that is "inspiration and/or expiration that does not provide adequate ventilation". Your goal might be: "Patient will report that he can breathe comfortably", especially with his c/o SOB. If you need more interventions, let me know. I always used Ackley & Ladwig's Nursing Diagnosis Handbook (which is where I'm getting a lot of these from!)

2) Powerlessness r/t possible cancer dx

Goal: Pt will participate in planning and implementing care; or patient will verbalize feelings and indicate ways he can cope (e.g. prayer, family support, etc.)

So in summary, I would choose:

1) Ineffective Breathing Pattern

2) Powerlessness

3) R/F falls (I like injury better because you can include so much more within the care plan...you're not so boxed in)

Good luck :)

[hlneumann]

Wow.. I was also looking for dx for my pt... he has SOB, and wasn't sure. Should have known Maslow would be mixed up in this!!! LOL