Help with Careplan...

[apromm]

hi, i have a 57 year old patient with no medical history. he has no use of tobacco, alcohol, or drugs. however, he was going to the gym 4-5 x's a week and taking "work-out supplements." his urine was + for benzodiazopines. he went into cardiac arrest at home. cpr was immediately initiated for 10 minutes. at 10 minutes the defibrillator arrived. he was shocked twice. he is now at the hospital sedated on propofol and vented. (tv 600, fio2 40, rate 10, peep 8) he does not have any abnormal abg's. he has a normal temperature, bp's range 110/63-130/75, map 73-89, resp 12-16, hr 53-57, spo2 95-99. he is on an amidoarone and lidocaine drip. other medications include nexium, aspirin, zosyn, silvadene, heparin sq 5000 units, and novolin r. his labs came back with a decreased albumin (2.9), phosphate (2.1), rbc, hgb, hct, and platelets. his sgot/ast was highly elevated (61) and creatinine only slightly elevated (1.4). a hit panel was sent off yesterday. his ct's show no aneurysms or dissections, or incranial bleed. there is a suspicion of mild right lower lobe infiltrate. upon assessment he only opened his eyes to physical stimulation (he was sedated). he generalized edema 1+. his lung sounds were diminshed at the right base and he had a scant amout of thick, tan/bloody sputum. he also had a productive cough. his abdomen was soft but slightly distended with hyperactive bowel sounds. he was on tf at 50 cc/hr. however, we turned the sedation off later in the day and he opened his eyes to verbal stumuli, had strong hand grasps bilaterally and followed command. he became to aggitated and we had to increase sedation. anything not mentioned was normal. my nursing diagnoses for him are:

1. impaired gas exchange r/t ventialtion perfusion imbalance

2. decreased cardiac output r/t altered rhythm and stroke volume

3. decreased tissue perfusion: cerebral?? (i need something to do with neuro... he was on sedation since he arrested. they tried to take him off once and he was not tolerant, on the day that i took care of him he followed verbal command and opened his eyes but he was very aggitated...)

4. risk for infection (he is on prophylactic zosyn, vented, and has burns on chest from shock)

5. moderate anxiety (he was very aggitated when sedation was taken off... he grimaced, tried to yank at vent, started choking, he cried, and he couldn't sit still)

any input would be greatly appreciated. thanks!