Published Nov 22, 2009
ashleyisawesome, BSN, RN
804 Posts
I'm working on my nursing process paper, and I'm trying to figure out which diagnosis would be more of a priority:
excess fluid volume r/t CHF AEB dyspnea, bilateral lower extremity edema, potassium level of 3.3 MEq (low), pleural effusion
OR
ineffective cardiopulmonary tissue perfusion r/t decreased hemoglobin concentration in blood AEB dyspnea, BLE edema, decreased urination, RBC count of 3.37, HGB count of 10.3, fatigue, respiratory alkalosis
I'm not sure if impaired tissue perfusion is caused by the excess fluid volume, or if the excess fluid volume is caused by the ineffective tissue perfusion. Can someone please explain it to me? and which one you would use as a priority diagnosis in a CHF patient who is in the hospital for SOB and severe BLE edema?
thanks!
melmarie23, MSN, RN
1,171 Posts
I'd go with the first, excess fluid volume-simply because of the ABC's. Difficulty breathing, to me, would be the highest priority. I might even redo that diagnosis to something of the following:
ineffective breathing pattern r/t compromised pulmonary function AEB pleural effusion, BLE edema and hypokalemia
or
impaired gas exchange r/t extravasation of extravascular fluid in lunch tissues and alveoli AEB pleural effusion, BLE edema and hypokalemia
Daytonite, BSN, RN
1 Article; 14,604 Posts
tissue perfusion diagnoses are always sequenced before the fluid diagnoses because they have to do with oxygenation of the tissues. with oxygen, the heart and lung tissues suffer pretty quickly and cause heart arrhythmias and death. it takes a few days for someone to die from fluid problems. however, there are also problems with the construction of your nursing diagnoses.
[*]excess fluid volume r/t chf aeb dyspnea, bilateral lower extremity edema, potassium level of 3.3 meq (low), pleural effusion
you can read about chf on this website: http://cvphysiology.com/index.html - cardiovascular physiology concepts, click on "heart failure" link at the left side of the page
wow thanks a lot. you really helped me out. i have a little trouble with these diagnosises.