Help needed for nursing diagnosis!!!

[milogirl]

Hello!

Im currently working on a case study.

The patient has bilteral pleural effusion & pulmonary edema. Her main condition is heart failure.

She has low SpO2, tachycardia & tachypnea, SOB. Nth was mentioned abt the use of accessory muscle to breathe.

So im wondering for the nursing diagnosis shld i put impaired gas exchange since theres's alveolar-capillary membrane changes or should i put ineffective breathing pattern since bilateral pleural effusion will lead to difficulty in chest expansion.

Btw, whats the difference b/w impaired gas exchange and ineffective breathing pattern?

Many Thanks!!! (:

[Keri8680, BSN, RN]

Ineffective gas exchange takes place more at a cellular level, think O2 intake and CO2 output....I think the low spO2 would support this, also the fluid in the lungs would hinder it as well by blocking the alveoli gas exchange.

The ineffective breathing pattern would be supported by SOB. Both woudl be appropriate for your nursing dx.

Ineffective gas exchange r/t bilteral pleural effusion & pulmonary edema AEB low spO2 (give numbers here)...

Impaired breathing pattern r/t bilteral pleural effusion & pulmonary edema AEB SOB...

Your nursing dx book can give u more info on these and more examples for your AEB that your patient may have experienced, which will further back up your dx.

Hope this helps.

[sh1901]

I agree 100% with pp on this one.

[Daytonite, BSN, RN]

diagnosing is based on the symptoms that the patient has. you need to use a nursing diagnosis reference to help you out here. if this patient has heart failure, i would also be looking for signs and symptoms of decreased cardiac output.

• see decreased cardiac output
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=09 - decreased cardiac output
  

she will have both respiratory diagnoses (problems). . .

the confusion about impaired gas exchange (definition: excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane) gets asked a lot on the student forums. i explained the related factors about it in this thread some time ago: https://allnurses.com/general-nursing-student/asthma-impaired-gas-302401.html. alveolar-capillary changes only occur when there has been some chronic disease present such as copd, interstitial disease or cancer--something that is irreversible, has altered the alveoli and affects the oxygen/carbon dioxide exchange ability. if the problem in the alveoli is temporary and is expected to be reversible then the cause (related factor) is a "ventilation perfusion imbalance". the low spo2, tachycardia, and sob are symptoms of poor gas exchange (caused by a "ventilation perfusion imbalance"). a set of abnormal abgs would be nice to have as well, but you have what you have.

• see [color=#3366ff]impaired gas exchange
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=23 - impaired gas exchange
  

ineffective breathing pattern (definition: inspiration and/or expiration that does not provide adequate ventilation) has to do with the physical act of breathing air in and the breathing air out of the lungs themselves. we are now speaking of the entire organ as one entity. difficulty in chest expansion is a symptom of this diagnosis. but so are tachypnea and sob.

• see ineffective breathing pattern
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=08 - ineffective breathing pattern
  

with a bilateral pleural effusion and sob i would expect this patient to have excess fluid volume. it's related to the type of heart failure going on. the symptoms are probably systemic as well. some of these symptoms will be listed with the decreased cardiac output because the heart and lungs are so closely related. when one organ fails so does the other when it tries to catch up. this lady is a sick cookie.

• see excess fluid volume
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=22 - excess fluid volume
  

all of the websites i listed above for you have the related factors (causes) and the defining characteristics (symptoms) for each of these diagnoses to help you understand what these diagnoses mean. they also include interventions.

[Daytonite, BSN, RN]

ineffective gas exchange r/t bilteral pleural effusion & pulmonary edema aeb low spo2 (give numbers here)...

impaired breathing pattern r/t bilteral pleural effusion & pulmonary edema aeb sob...

bilteral pleural effusion & pulmonary edema are medical diagnoses. you cannot use medical diagnoses in nursing diagnostic statements. additionally, "bilteral pleural effusion & pulmonary edema" do not sufficiently explain why the alveoli are failing to exchange oxygen and carbon dioxide and "bilteral pleural effusion & pulmonary edema", as well, do not sufficiently explain why the lungs are not inflating and deflating adequately.