Figuring out my third ND

  1. I am working on a care plan, and as much as I love writing up the patho and looking at how everything interconnects, I really struggle with nursing diagnoses.

    This patient came in with a recurrent growth of colon cancer, metastasized to lymph nodes. Had internal bleeding, wound dehisced, coded, next surgery had STEMI.

    Also has COPD and pneumonia. Two abdominal JP drains with purulent and saresangenous drainage.

    The two I have come up with are- (we have to have one psychosocial, and none of them can be at risk for or pain).

    Ineffective denial related to threat of unpleasant reality as evidenced by dismissive gestures, flat affect, not perceiving the relevance or danger of his symptoms, stating, "I am going home" and "go away" when discharge discussions are attempted.

    Ineffective airway clearance related to accumulated secretions secondary to COPD and pneumonia as evidenced by diminished breath sounds with course crackles in left and right lower lobes, ineffective cough and patient stating, "I can't get any of this gunk to come out".

    I am really struggling to come up with another. I have included the need for movement, getting out of bed with my goals and interventions related to respiratory. We can't use pain, and none of his assessment data or labs leads to anything outside of infection that he already has. His ABG's are all within normal limits. He is too thin, but also NPO and on TPN.

    I know that during the STEMI he lacked circulation for 8 minutes, affecting his liver and kidney perfusion. His creatinine is low and he is anemic. What should I be looking towards for my NDx? H also has dark, amber urine in his catheter. Lymphocytes are low, monocytes are high. Glucose is high.

    Any help would be greatly appreciated. Also, I am using Nursing Diagnoses Manual by Doenges, and Nursing Diagnoses Handbook by Ackley.
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    About Teacher17

    Joined: Mar '16; Posts: 29; Likes: 3

    7 Comments

  3. by   ItsThatJenGirl
    ND's aren't just things the patient is experiencing, but possible complications, too - right? (I'm new to this). So could you identify depression (or maybe something like disturbances in regulation of mood)? Or maybe ineffective coping?

    You could also go for the obvious fall risk, or risk of impaired gas exchange.
  4. by   Teacher17
    I already did one psychosocial, the ineffective denial. And I already did airway, though your suggestion is impaired gas exchange it is too similar. And fall risk is a risk, which we are not allowed to include :/ Thank you for the ideas though!
  5. by   KrystalBSNStudent
    What about skin integrity/infections risk/wound healing complications due to high glucose, low O2, poor diet, WBC count...or is that too close to gas exchange?
  6. by   Teacher17
    Would healing with high glucose is awesome. Thank you!
  7. by   WanderingWilder
    Impaired tissue perfusion, imbalance nutrition less then body requirements. decreased cardiac output.
  8. by   PaSSiNGaS
    Regardless of it being a nursing diagnosis or differential diagnosis you need to think ABCs. The patient has had a MI in the past so number 1 on the list should be related to circulation or oxygen supply/demand. Think of things like decreased cardiac output, Risk for decreased cardiac tissue perfusion, Risk for ineffective cerebral tissue perfusion
  9. by   Tprofitt
    I'd definitely lean towards the decreased cardiac output. You have so many AEB's/AMB for that.

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