So a little background on my patient. He came in through the E.D. SOB, 3L NC O2 as 90% they gave him a breathing treatment his O2 went to 100%. He has a history of COPD and has been intubated several times in the passed. He was put on Bipap but his LOC decreased and they decided to intubate. When I had him he was in the ICU, intubated, ABGs were all out of whack, as to be expected. His O2 sat was running from 93-100 he still has wheezes and decreased breath sounds. Many of the Nursing diagnosis that I have found are for COPD patients that are not currently on mechanical ventilation. Right now I am trying to figure out 3 top diagnosis and then prioritizing them. I have- Ineffective airway clearance r/t expiratory airflow obstruction, bronchoconstriction AEB wheezing, difficulty breathing, impaired gas exchange r/t ventilation perfusion inequality AEB abnormal ABG values, reduced tolerance for activity, risk for infection: risk factors: inadequate primary defenses, chronic disease process, malnutrition. He had a chest x-ray and there was no pneumonia just overinflation and presence of chronic lung disease. Do you guys have any advice on better nursing diagnosis/ better prioritization?
