Help! Concept Map Confusion

[MsBrain, MSN, DNP, RN, APRN]

There are some things I need to improve on my concept map for med surg, but I need some pointers. I have included an overview of my patient as well as my prioritized nursing diagnoses. I was told that the risk for impaired cardiovascular function should have been my # 1 priority, but I though an actual diagnosis took priority over a risk for diagnosis. I was also told that some parts of my interventions were unrealistic. What would be some more realistic interventions for my top 3 nursing diagnoses?

HPI: The patient was admitted to the hospital after experiencing violent coughing and difficulty breathing.

Temp: 37.4 BP: 133/60 HR: 141 RR: 22 Pain: 0 O2 sat: 99

Neuro: Alert, A&O x 3, appropriately responds to questions, slurred speech, PERRLA

Resp/O2: clear breath sounds bilaterally, labored, even rhythm, symmetrical chest expansion

Cardio: S1 and S2, no murmurs, rubs, or gallops, RRR, cap refill

GI: Rounded abdomen, BS +X4Q, soft abdomen, small BM, soft, brown, last BM: 01/26/17, intermittent G-tube feeds

GU: Incontinent, non-distended bladder

MS/Activity: obese, limited ROM, normal muscle tone, weak muscle strength, swelling of the right arm, bed bound

Skin: pink, warm, dry, smooth, slow recoil, 2 unstageable pressure ulcers on left sole of the foot, white wound on the outer left ankle, flaking and peeling of the skin on the bottom side of the left thigh.

Nursing diagnosis

#1 Impaired skin integrity r/t: physical immobilization

AEB

· 2 unstageable pressure ulcers on left sole of the foot

· White wound on the outer left ankle

#2 Impaired physical mobility r/t: previous stroke

AEB

· Inability of move purposefully within physical environment

· Inability to perform action as instructed

· Limited ROM

· Hemiplegia

#3 Risk for impaired cardiovascular function r/t: tachycardia

AEB

· Normal saline fluid bolus (999 mL/hr)

· 3+ radial pulse

· Elevated lactate (3.7)

#4 Risk for aspiration r/t: impaired gag reflex

AEB

· G-tube feeding

· Inability to elevate upper body

#5 Risk for constipation r/t: immobility

AEB

· Bed bound

· Low fiber diet

· Lisinopril

· Metroprolol succinate

Care plan

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