Care plan insight please?

[obicurn]

Can someone please give me some insight? I've been working on a care plan for a pt with pneumonia. She is a Diabetic, Type I and has peripheral neuropathy unrelated to the diabetes.

Abnormal labs:

RBC 3.06

Hbg 8.8

Hct. 25.6%

WBC Diff:

-Lymphoctes 17%

-Monocytes 12%

Chem Panel

-Na+ 132

-BS 199

Coagulation Labs

-PT 21.3 (pt. on coumadin therapy)

INR is normal

I have focused my nursing diagnoses on the pneumonia because that was the admitting diagnosis. I am now wondering if I should maybe lean more towards the diabetes aspect.

The ND I have come up with....We must have at least 6 in our care plan, and choose the 3 top priority to make a care plan on.

1. Impaired gas exchange r/t presence of fluid and mucous in lungs

2. Ineffective airway clearance r/t retained secretions

3. Ineffective tissue perfusion r/t decreased cellular exchange

4. Activity intolerance r/t increased oxygen demands with activity

5. Acute pain r/t inflammation of lung tissue

6. Deficient knowledge r/t lack of information about pneumonia and treatment

Have I even worded these the right way? I feel like I'm missing something here that should be pretty obvious. I've been sitting here since 8 am yesterday working on this, minus the 5 hours I slept last night. I'm going cross-eyed at this point. She is also on many different drugs that list orthostatic hypotension as an adverse effect. Should I use Risk for injury as one of my diagnoses?

If anyone can point me in the right direction I will be forever grateful! I have to have this handed in tomorrow morning and I'm going nutso trying to nail down my wording.

Thanks!!!!

[Daytonite, BSN, RN]

you list no signs or symptoms that this patient has, so i can offer very little help. looking at your diagnoses. . .i would suggest a different sequence and these changes:

1. impaired gas exchange r/t presence of fluid and mucous in lungs
   
   • the presence of fluid and mucus in the alveoli of the lungs results in a ventilation perfusion imbalance (which is the same as the decreased cellular exchange in the diagnosis below) which is the etiology of impaired gas exchange.
     
   • your diagnosis should read: impaired gas exchange r/t ventilation perfusion imbalance
     

[*]ineffective tissue perfusion r/t decreased cellular exchange

• you must specify which organ system is involved in the ineffective tissue perfusion. i suspect you mean the lungs. this, however, is covered by impaired gas exchange.
  

[*]activity intolerance r/t increased oxygen demands with activity

• i think you mean "imbalance between oxygen supply and demand" for the related factor
  
• see activity intolerance - you must show that the patient has elevated heart rate and pulse with activity if you use this diagnosis
  

[*]ineffective airway clearance r/t retained secretions

[*]acute pain r/t inflammation of lung tissue

[*]deficient knowledge r/t lack of information about pneumonia and treatment

• you must specify a subject along with deficient knowledge
  
• your diagnosis should read: deficient knowledge, pneumonia and treatment r/t lack of information
  

this patient is hyponatremic. i'd consider using deficient fluid volume r/t active fluid volume loss. with blood sugars of 199 she may be dumping glucose through her kidneys along with water and sodium and probably somewhat dehydrated. look for other signs of dehydration. also her h&h is low another sign of a low fluid volume. a patient on coumadin is always at risk of injury r/t altered clotting factors. they need to be protected from and monitored for bleeding.

[obicurn]

Thank you, Daytonite!!!!!! I will go back and alter my care plan using the info you have supplied. I'm off to bed as soon as I finish that. Nursing school is really taking it out of me!!