Help with care plan PLEASE!

[kimkICURN]

Y'all, I need help please!!! I have a case study and I'm having a hard time trying to diagnose my patient. I want to to decreased cardiac output but I don't have enough information to support my diagnosis. So, would risk for decreased cardiac tissue perfusion be next?

39 y/o Male admitted to the unit with c/o CP and nausea. Wt: 200lbs, 5'5", BMI 33.3%. PMH: HTN and HLD. On antihypertensive meds for 6 months. VS: HR 95, RR 22, BP 164/90, o2: 92% on R.A. Difficulty losing weight d/t lack of time. 10lb weight loss in 4 months. Recurrent heartburn, SOb, radiating pain to torso and left arm. He is agitated and tapping his foot on the ground. He is a Wall St. analyst, lives with wife and reports marital issues.

I wanted to do decreased cardiac output, acute pain, anxiety, and ineffective health maintenance or imbalanced nutrition but I'm having trouble. Please help!

[MiladyMalarkey, ASN, BSN]

Have you referenced a nursing diagnosis handbook? That helps immensely. If you don't have one, purchase one.

[kimkICURN]

Yes, I live by my NANDA book. I'm still torn at these two diagnoses.

[kaylee.]

What is possibly going on here? The chest pain whether its actually cardiac or not (you dont know yet) is your priority.

So what is happening with cardiac chest pain? There is an alteration of perfusion to an area of the heart muscle. Although trying not to completely give you the answer, there may be a valuable ndx in some of the phrasing i just said. If you want to learn or understand, think about the patho of chest pain, both ischemia and infartion.

Then there are also clues for some long term modifiable risk factor changes that the patient can make. I think there mention should be a hint to include such ndx in your care plan.

[kaylee.]

Also, what is cardiac output? Does your patient present with evidence of decreased cardiac output. Try to learn what the things are before getting puzzled on whether they fit as part of your care plan.

[kimkICURN]

I wanted to do ineffective tissue perfusion but only peripheral tissue perfusion is in my NANDA book and I dont have enough data to support that. Although the related factors mimic my patient.