COPD is medical dx labs point to kidney dysfunctyion

[Kkare]

Hi I'm a new older nursing student and new to posting threads (please be patient). I had my first clincal on Friday and my write-up is due Monday. I almost get it. I need to come up with 2 NANDA's and support with subjective and objective data. My pt is 82 yr female admitting dx: COPD, Asthma, Diastolic Failure. vs= p-96, rr-20 b/p-134/58 o-94. Labs RDW-15.7 (H), Est. GFR 35 (H)-stage 3 kidney disease, lymphs 11.3 (L), Eosins 7.6 (H), BUN 30 (H), Creatinine 1.3 (H), glucose fast 170 (H), Albumin 3.3 (L), d-dimer 339.2 (H) and u/a wbc 20-29 (H of abnormal) and u/a rbc 3-4 (abnormal). Cc on admission were sob, dyspnea and edema in ble. Pt has bilateral wheezing. My question is how do I connect everything? I was going to set up the nursing dx as "Impaired gas exchange r/t alveolar-capillary membrane changes aeb dyspnea, increased rr 20, increased hr 96, decreased O2-94 and adventitious breath sounds." for my first nursing dx and my 2nd dx as "Ineffective airway clearance." Can I use the same aeb factors for both dx? Also, the labs seem to be point to kidney issues that are no where in her chart. How do I use labs to support? Or, is there a better nursing dx that I could use for this pt?

[tencat]

It's been a while since I've been in school, but let's see if I remember. I like ineffective airway clearance as she had a complaint of shortness of breath and has wheezing. However the other diagnosis does not address the other issues that are happening with the patient. Look at the patient's perfusion....is it good? There is a lot more going on than just the breathing, though that is a big part of it. You've got heart issues and kidney issues.....when looking at diagnoses, I think you're looking for the things that are most likely to kill the patient as being the most important ones. If you can't breathe and perfuse, you're going to be in trouble. Hope that helps. (and hope I'm right! :) )

[nicoleRN831]

I would use a dx related to her renal issues... Ineffective tissue perfusion (renal) and your supporting data can be

Est. GFR 35 (H)-stage 3 kidney disease, BUN 30 (H), Creatine 1.3 (H), u/a wbc 20-29 (H of abnormal) and u/a rbc 3-4 (abnormal)

You dont want to use 2 dx's that are the same when the person has alot of other issues going on with her.

There is this great book for nursing dx's and for nursing interventions its called Sparks and Taylors nursing diagnosis reference manual. I have been using this book for all my care plans and it really helps me.