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Discussion

Care plan help...

I am struggling with a priority nursing dx. Maybe someone out there can help me? Or at least let me know if I am on the right page...

Pt has hx of asthma, atelectasis, anemia. Presented with abdominal pain which has been controlled (enlarged liver/spleen). Pt is tachycardia, sob, weak/fatigue.

I was going to use Impaired Gas Exchange r/t atelectasis and then Activity intolerance r/t anemia. Or...should I be using deficient fluid volume r/t anemia since their is a risk for bleeding? I am so confused.

Any help would be great!

Thanks

S

Featured Replies

  • Author

I forgot to mention...pt also has decreased I/O.

  • Experts

Are you absolutely sure the abdominal problem is resolved because enlarged organs could be pushing on the pulmonary organs acerbating some of his breathing problems? You say the patient is anemic? Why? Liver problem?

That aside, go with your ABCs (airway, breathing, circulation) to set priorities. Then your electrolyte problems because they can affect the heart and circulation. Anemia is low on the list even though it can contribute to an oxygenation problem. It is also most likely tied in to a liver problem as well.

Is this a patient with cirrhosis and/or ascites?

  • Author

Thanks daytonite for responding...

The pain of the abdomen has decreased. The pt does have a liver problem...it just hasn't been dx yet. Bx will be done once anemia - blood clotting issue is resolved. The enlarged liver & spleen is what the pt came in for.

I was actually going to use the Impaired Gas Exchange and Fluid Volume Deficit since the pt has a severe decrease in I/O. Since the dx has not been established of the organ, only guesses right now...I'm assuming I'm going with the pt's current response correct? So confused!

  • Experts

Yes, I think that is probably right. Look at what the majority of the doctor's orders are aimed at. It they are attending to the dehydration/electrolytes and breathing problems at the moment, then, yes, those should be your leading nursing diagnoses. I think they are both serious enough that they have equal weight, so either one could be listed first, although I'd go with the gas exchange listed first to follow the ABC priority. Nice job of critical thinking.

Don't be afraid to consider the doctor's progress notes and what the doctor is addressing as the major problems for thelr patients as well as the treatment orders they are writing. It is important that we also be on the same page as the doctor when it comes to treating the patient as well.

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