Does Ineffective Tissue Perfusion r/t decreased hemoglobin sound right??

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I am trying to write one of my last care plans for this rotation and I just feel out of whack! I have a pt with liver cancer, COPD, hyperlipidemia, history of smoking and low RBC, hct, and hemoglobin. She is on 1-2L nasal cannula. The (second) best diagnosis I can think of is ineffective tissue perfusion, but for some reason the wording just doesn't sound right to me. Is there a better diagnosis out there for low hemoglobin? That is what I am really trying to focus on for this diagnosis! Thank you!!

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Do you have any VS? I would put the "decreased Hct" as an AEB, since AEB = S/S. Maybe decreased tissue perfusion r/t causative factor AEB decreased Hct, decreased Hgb, decreased RBC (but put the actual values of the labs). I feel like there's not enough information in the data you provided for me to be able to determine the r/t section. I hope that helps a little. Nursing Dxs are hard!

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Specializes in ICU.

I guess I'm confused as to why you are using a lab to make a diagnosis? Maybe if you could explain it better to me. The low RBC, hematocrit, and hemoglobin are lab values which you should be using as your AEB for the other issues. My understanding is you don't use a single lab value and come up with a nursing dx. The lab values should be your AEB for your nursing dx. I feel like you are trying to get a nursing dx from a lab value. You can't do that. You have a lot of things for good nursing dx. I would think the liver cancer or hyperlipidemia would give you tons. The COPD and smoking hx also. But, I don't know why your pt was admitted to the hospital or why these labs were run. We don't know the VS. Do you have a focus on this care plan? When I do mine, I look at why my patient was admitted and then I will use that as my main part of the care plan, if you are in a hospital rotation. In LTC, I looked at the main reason they were there, but that doesn't always tell the whole story so I will delve into their other issues. I just think you are barking up the wrong tree trying to put a nursing dx on low hemoglobin. What does that mean? Does that make sense?

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Oxygenation should be priority if this patient is not normally on supplemental oxygen.

Ineffective gas exchange R/t ......2° to COPD, and anemia AEB....vs, labs, pt assessment data

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Specializes in Neuro, Telemetry.

I wasn't aware that decreased Hgb was a cause of ineffective tissue perfusion. Did you get that out of your NANDA book? For real nursing dx, the r/t (caused by) will come straight from the book because each dx is defined by certain things. The Hgb would be an AEB factor but not an actual causative factor as far as I'm aware. If you are set on this dx, then find the AEB listed that has to do with circulatory issues if they apply. Then use the Hgb as one of your AEB s/s. I would be more concerned with why they are on O2 first. I mean, I can pretty much assume why, but breathing would be a priority over circulation. Unless the O2 has to do with circulation, which is very possible with the low H/H labs.

But, there really isnt enough info here to form a dx. Where is your assessment data? If you have to make your careplan and d/x before meeting your patient (which I hate) then did you look at the nurses admission assessment in order to better formulate your d/x. Thats what I've done when a careplan is required to be done before meeting my patient. Then I change some stuff as needed throughout the clinical shift before turning in the final product.

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I wasn't aware that decreased Hgb was a cause of ineffective tissue perfusion. Did you get that out of your NANDA book? For real nursing dx, the r/t (caused by) will come straight from the book because each dx is defined by certain things. The Hgb would be an AEB factor but not an actual causative factor as far as I'm aware. If you are set on this dx, then find the AEB listed that has to do with circulatory issues if they apply. Then use the Hgb as one of your AEB s/s. I would be more concerned with why they are on O2 first. I mean, I can pretty much assume why, but breathing would be a priority over circulation. Unless the O2 has to do with circulation, which is very possible with the low H/H labs.

But, there really isnt enough info here to form a dx. Where is your assessment data? If you have to make your careplan and d/x before meeting your patient (which I hate) then did you look at the nurses admission assessment in order to better formulate your d/x. Thats what I've done when a careplan is required to be done before meeting my patient. Then I change some stuff as needed throughout the clinical shift before turning in the final product.

If she has data to support i.e assessment data, then Ineffective tissue perfusion R/t decreased oxygen carrying capacity aeb low H and H would work but it better be pretty low and the patient should have s/s as well.

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Perfusion is blood flow. Hemoglobin level is not a determinant of blood flow. Therefore you cannot make a nursing diagnosis of decreased perfusion and say low hgb either caused it or is evidence for it. Hint: I think what you're grasping for relates to tissue oxygenation, not perfusion. Lousy perfusion can cause problems with tissue oxygenation, but you can have lousy oxygenation with perfect or even high perfusion...why?

I'm not at my computer so I can't give you the more comprehensive answer this minute. What I want you to do is go to the Search box at the top of the page and type in "Nursing Diagnosis GrnTea" and "Nursing Diagnosis Esme." You will find a number of posts that will help you get out of the bit of a rut you're in and rethink they whole thing in a much more effective way.

Back later. Let us know what you think when you've done it.

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Can you use pain? The pt may have impaired clotting. All types of psychosocial problems I would think. Oxygen exchange? So many dx you could probably come up with.

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Perfusion is blood flow. Hemoglobin level is not a determinant of blood flow. Therefore you cannot make a nursing diagnosis of decreased perfusion and say low hgb either caused it or is evidence for it. Hint: I think what you're grasping for relates to tissue oxygenation, not perfusion. Lousy perfusion can cause problems with tissue oxygenation, but you can have lousy oxygenation with perfect or even high perfusion...why?

I'm not at my computer so I can't give you the more comprehensive answer this minute. What I want you to do is go to the Search box at the top of the page and type in "Nursing Diagnosis GrnTea" and "Nursing Diagnosis Esme." You will find a number of posts that will help you get out of the bit of a rut you're in and rethink they whole thing in a much more effective way.

Back later. Let us know what you think when you've done it.

According to NANDA, unless it has changed, it certainly is a determinate of ineffective tissue perfusion

Anemia was definitely on that list last time I looked.

What is the purpose of blood flow?

To carry OXYGEN to cells, tissue, organs etc....

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According to NANDA, unless it has changed, it certainly is a determinate of ineffective tissue perfusion

Anemia was definitely on that list last time I looked.

What is the purpose of blood flow?

To carry OXYGEN to cells, tissue, organs etc....

It is not a determinate, that is, hemoglobin (or anemia) does not determine/influence/control blood flow. Of course blood flow carries oxygen, and CO2, and fluids, electrolytes, proteins, waste products, immune complexes, and lots of other stuff. If you see something in the current NANDA-I that indicates changes in hemoglobin level or anemia as a related/causative factor in perfusion, please cite it. I'm not seeing it in my copy.

I reiterate that you need to separate perfusion, that is, the physical flow of blood through the arterial vessels through the capillary bed, from what is carried by that blood. It is perfectly possible to have terrific perfusion, even hyperperfusion, in the presence of any possible level of hgb/anemia.

I believe the OP is trying to find a way to say there's a nursing diagnosis relating decreased oxygen-carrying capacity to tissue oxygenation in some way and hasn't quite figured out how to get there (I would suggest taking a look at the nursing diagnoses on injury prevention-- low oxygen-carrying capacity would increase risk of tissue injury from pressure, decreased healing, etc.).

I encourage her, and you, to reconsider your impulses to draw a straight line between hgb and blood flow regulation. Oxygen is carried by blood via hgb, but as stated, she is wrong to call hgb level causative to blood flow regulation.

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