Help with nursing dx, please :)

[sparklie.lady]

Evening, all...

I am really struggling with this dx. (We do two for our care plans.)

Anyway, patient is 59 y/o M, with HTN, ETOH, who is post op from getting a neobladder (bladder CA). Hx of 2ppd smoker, but quit 8 years ago. Anyway, his O2 sats tanked post op--he could not sustain 92 without being on at least 2L. Diminished breath sounds bilaterally in lower lobes, RR was regular but shallow. CXR showed some infiltrates, but no other s/s of pnuemonia or mets. Repeat CXR 2 days later showed improvement.

In terms of priority, it seems that dealing with this issue would be tops on the list. The best dx I can come up with is impaired gas exchange. But, I can't seem to get a handle on the r/t. The AEB is the decreased sat levels. Am I comping at this the wrong way?

My other dx is risk for injury r/t altered cerebral function secondary to ETOH withdrawal.

Any advice would be greatly appreciated. Thanks!

[criticalRN10]

I would definately do respiratory status as priority, remember ABC's! you could do r/t anesthesia or ventilation-perfusion imbalance.

[TRR8021]

Yeah, it seems like a result of surgery anesthesia and probably narcotics if he's on them (respiratory depression.) Is he using morphine or Dilaudid for pain?

[sparklie.lady]

Thanks, guys! I did got with ineffective tissue perfusion r/t infiltrates in the lungs (which I missed reading on a CXR). I really appreciate your help!