Help with Nursing diagnoses

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Hi All, I have been a first year nursing student for about 8 months now, and am currently on my first clinical placement - Eeek! - So our placement is in a rest home and we all have a resident who has kindly allowed us to undertake a comprehensive assessment of them and practice our physical assessment techniques too! :-) So far so good except we are now expected to write care plans and prioritise 3 nursing diagnoses. So far my top three are risk for decreased cardiac tissue perfusion r/t aging process. Risk for falls r/t wheelchair use secondary to CVA and Risk for complications due to immobility r/t L) sided hemiparesis secondary to CVA. My patient has a history of IHD, hypertension and PAF. Is on B blockers etc and Glyterin spray for angina and had a recent episode a month ago of tachycardia and chest pain and was rushed to hospital. I'm just wondering if my diagnoses are on the right track? Some other students said because his cardiac condition was stable it is no longer a priority? Any help would be so greatly appreciated! Thank you :-)

Also he has been prescribed an inhaler for intermittent wheeze even though he is not asthmatic. He has been in the rest home a year now and told me he never used an inhaler till he was in the rest home. I'm starting to think he may have cardiac asthma? Apparently taking an inhaler for cardiac asthma is very dangerous as it can cause increased heart rate and arrhythmias (which my pt had last month!) I'm really worried about him :(

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When it comes to instructions where one instructor said one thing then another said the opposite, your best bet is to clarify what is required of you from the grading instructor and follow that rubric.

How did you arrive at asthma because last I checked, asthma is a medical diagnosis. You are to focus on pt's symptoms then formulate Ndx. For instance, if wheezing was part of your assessment an example of a ndx would be impaired gas exchange. You may want to invest in a nursing diagnosis book and study it to help you understand better

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Specializes in Adult Internal Medicine.
I feel like my pt is in heart failure, I feel my 3 priority nursing Dxs should be the pain that he stated to me he was having in his hip, his oedema and SOB. At my nursing school the head of nursing told us to prioritize by what will kill them first. But my clinical leader at the rest home said that is not how to prioritize in a rest home setting! As far as I'm aware his edema and SOB isn't even being addressed. Is this normal practice?

I responded to your other thread on the same topic but I figured I would post here too.

You are trying to fit your nursing assessment and patients symptoms into a medical diagnosis. (Likely this pt does have chronic or acute on chronic dysfunction.) You don't have to do this. You did the assessment now find the nursing dx that for your assessment and then the nursing interventions for those dx.

If you clinical instructor told you not to use cardiac diagnoses then my advice to you is don't use them. That being said:

So the patient has mild to moderate lower extremity edema. What is this related to? What are nursing interventions for it?

The patient has some dyspnea. What are nursing interventions for this?

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I didn't "arrive" at asthma, I am only stating what I read in his notes. And after researching his medical history I read inhalers are sometimes wrongly prescribed to people who have "cardiac asthma". I'm not even talking about care plans and nursing Dxs anymore I was just interested in what experienced nurses thought about his symptoms

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Specializes in Pediatrics, Emergency, Trauma.
I didn't "arrive" at asthma, I am only stating what I read in his notes. And after researching his medical history I read inhalers are sometimes wrongly prescribed to people who have "cardiac asthma". I'm not even talking about care plans and nursing Dxs anymore I was just interested in what experienced nurses thought about his symptoms

Ahh, but here lies the disconnect.

Care plans help the student nurse THINK like a nurse; you are doing nursing care, NOT "medical care."

You've given some pretty interesting information related to your pt, but again, what did your assessment show???

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I responded to your other thread on the same topic but I figured I would post here too.

You are trying to fit your nursing assessment and patients symptoms into a medical diagnosis. (Likely this pt does have chronic or acute on chronic dysfunction.) You don't have to do this. You did the assessment now find the nursing dx that for your assessment and then the nursing interventions for those dx.

If you clinical instructor told you not to use cardiac diagnoses then my advice to you is don't use them. That being said:

So the patient has mild to moderate lower extremity edema. What is this related to? What are nursing interventions for it?

The patient has some dyspnea. What are nursing interventions for this?

Ok back to the school work then. Wouldn't the edema and dyspnea be related to decreased cardiac output?

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My assessment showed dyspnea,weak irregular pulse, pitting oedema, cool, slightly bluish feet compared to rest of lower legs. If I can't use anything cardiac as a priority what can I use? We can only choose one physical assessment and I did cardiovascular! It makes no sense to not use it as a priority! surely??!

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I'm just going to say to my instructor look lady my assessment was cardiovascular, so if I'm basing my care plan on my assessment it's going to have to be cardiovascular. PLUS the HEAD OF NURSING at our school said priorities are what will kill them first. So that's cardiovascular if she doesn't like it I'll talk to a different tutor because it makes absolutely no sense to me to pretend there isn't a cardiovascular issue here. He should have nursing interventions to alleviate his dyspnea and oedema!

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Specializes in Pediatrics, Emergency, Trauma.

If you can't use cardiovascular (even if that doesn't make sense), what was his respiratory status? What else happens when pts have dyspnea?

I can think of several nursing diagnoses not using cardiovascular; a few related to dyspnea and edema that have nothing to do with cardiovascular.

Do you have a care plan book?

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Specializes in Adult Internal Medicine.
I'm just going to say to my instructor look lady my assessment was cardiovascular, so if I'm basing my care plan on my assessment it's going to have to be cardiovascular. PLUS the HEAD OF NURSING at our school said priorities are what will kill them first. So that's cardiovascular if she doesn't like it I'll talk to a different tutor because it makes absolutely no sense to me to pretend there isn't a cardiovascular issue here. He should have nursing interventions to alleviate his dyspnea and oedema!

Not a great idea to approach it that way with your instructor.

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Oh I wish GrnTea or Esme were around to help here! They can make things so much more clear....

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I would have thought anxiety r/t to dyspnea? But when I mentioned to my pt he seems like he's short of breath all the time he just said it was fine, sometimes it gets much worse than that, he seemed to accept SOB as part of his life, does this have to be the case? Is there anything that can alleviate it for him? I haven't taken his Sap02 yet so will do that tomorrow.

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