COPD and CHF: ineffective resp func or break it down?

[WMH RN]

Hi,

Still working on our hospital's care plan revision. Looking at COPD and CHF. Initially I had used the nursing dx CHF: ineffective airway clearance and COPD: ineffective breathing patters. Now I'm wondering if I should use the dx ineffective resp function on both medical dx to cover both airway clearance and breathing patterns on both. Or should I just include airway clearance and breathing patterns for both medical dx?

Thoughts????

Thanks so much:confused:

[Daytonite, BSN, RN]

you must be using really old nursing diagnostic references. for copd use

• impaired gas exchange (covers the hypoxia) impaired gas exchange
  
• ineffective airway clearance (covers the mucus blocking the large airway and all the coughing and adventitious breath sounds) ineffective airway clearance
  
• ineffective breathing pattern (covers the dyspnea and wheezing) ineffective breathing pattern
  
• self-care deficits bathing/hygiene self-care deficit and feeding self-care deficit

for chf use

• decreased cardiac output (covers the failing and congested heart, arrhythmias, contractility problem with the heart, peripheral edema) decreased cardiac output
  
• activity intolerance (for the weakness and fatigue with activity) activity intolerance
  
• impaired gas exchange (covers the hypoxia) impaired gas exchange
  
• ineffective airway clearance (covers the mucus blocking the large airway and all the coughing and adventitious breath sounds) ineffective airway clearance
  
• ineffective breathing pattern (covers the dyspnea and wheezing) ineffective breathing pattern
  
• excess fluid volume excess fluid volume
  
• acute pain (for the ischemia due to the hypoxia) acute pain
  

[WMH RN]

Thank you for the suggestions. Actually my reference is Carpenito 12th edition copy righted 2008. Purchased specifically for this project. You would be blown over by some of the changes I have discovered.

According to this reference Decreased Cardiac Output is no longer an appropriate nursing diagnosis. It now tells you to use Potential Complication: Cardiac/vascular dysfunction to encompass all of the complications that could arise with cardiac dysfuction. Our VPN felt there had to be some degree of responsibility on nurses to know that some things are potential complications in a pts care and we shouldn't have to spell everything out in the careplans.

Impaired gas exchange wasn't even referenced in the text but was listed on the very back cover as still approved by NANDA. So initally I thought it had been removed.

Ineffective respiratory function is cited as encompassing ineffective airway clearance, ineffective breathing patterns, dysfunctional ventilatory weaning response and risk for dysfuctional ventilatory weaning response as a whole. When I read the definition of this one it lead me to believe this would cover the mass of respiratory problems the two diagnosis encompass vs several seperate diagnosis.

I did include activity intolerance, excess fluid volume, and self care defecit however did not think to include pain w/ CHF. So thank you for that recommendation. This entire experience has been eye opening. Thinking back to nursing school, I laugh at home much anxiety I built up about having to write careplans when really they are not that difficult of a concept. They just felt impossible at the time.

Again thank you for your help Daytonite

[Daytonite, BSN, RN]

Isn't it amazing how time and experience allay a lot of that anxiety we had in school over care plans? I can't convey that successfully to students, but I know that it is part of learning assessment.

Carpenito's care plan and charting flow sheet forms are all related. I would start by taking a look at your admission assessment sheet and daily flow sheet. What nursing diagnoses will an abnormal assessment lead you to? Go from there. I wouldn't depend specifically on what Carpenito says. I would use her book as a guide. Take what you can from her book and ignore what isn't going to work for your facility. She's off at whoever employs her doing her thing. It works for where Carpenito is employed. That doesn't mean it will work at your facility because your facility has different circumstances. You might want to look at other care plan books. They might have workable solutions you can use.

Carpenito is a professor of nursing, very knowledgable about nursing process and nursing diagnosis and a long time, really long, member of NANDA. If you are being asked to use this book as a reference and guide, I would strongly recommend that you sit with it and read the beginning chapter(s) so you understand where she is coming from with the way her book is set up. I have one of her earlier care plan books and it was what I had to do to understand how the care plans were presented. She has her own ideas on nursing diagnosis. Carpenito, for some time, was working with what are called critical pathways for care plans and nursing charting. Is that in the book you purchased? Most facilities do not use that kind of care plan format. My Carpenito care plan book has sample critical pathways in it. Critical pathways assessments include assessing for potential complications which is why that information is included in her care plan book.