Help please with NANDAs for pneumonia

[ElleBea]

If anyone could please help me with 5 NANDAs for pneumonia or let me know if you guys think of something better.

My patient is a 15 month old male with left lower lobe pneumonia and dehydration. His Chest PA and Lateral and CT showed opacity/consolidation in the left lower lobe with a large area of pleural effusion. Regions of dense consolidation medially in the right upper lung lobe. They also showed infiltrate in the left perihilar region, and increased opacity in the right perihilar region. His culture came back with gram positive cocci in chains that they believe is steptoccus pneumoniae. On the last day that I had him as a patient they placed a 10 French left pleaural pigtail drain. He never c/o or showed s/sx of pain. His vitals over 3 days were temp 36.4-38.6, pulse 113-160, resp 22-50, BP 81/51-112/73, and SaPO2 93-100% on periodic O2 but mostly RA. His lungs had course crackles and were diminished throughout bilaterally and were very diminished/absent in the left lung base and he had mild retractions. He presented to the ER with a fever, cough, difficulty breathing, hypoxia, and dehydration. However, he wasn't coughing during the times that I cared for him. He was on a continuous infusion of D51/2NS 20meqKCl @ 40ml/hr. He was also on 100mg Vancomycin IVP and 750mg Rocephan IV, but he was getting worse.

The NANDAs that I have so far are

1) Impaired Gas Exchange r/t decreased functional lung tissue AEB hypoxia? (I'm not sure what to put here because his O2 stats are okay)

2) Ineffective Airway Clearance r/t inflammation and presence of secretions AEB course crackles and diminished lung sounds throughout bilaterally and diminished/absent in left lower lobe

3) Ineffective Breathing pattern r/t respiratoy illness AEB mild retractions, tachypnea, and dyspnea

4) Inbalanced Nutrition: less than body requirements r/t loss of appetite AEB decreased in oral intake at home, NPO diet in the hospital, and decreased output

5) I'm drawing a blank on a 5th NANDA

If you guys can help at all, think they need prioritized differently, or think of something better please let me know.

Thanks!

[RNTutor, BSN, RN]

A couple of ideas...

How was his mouth? Was he mouth breathing? Between dehydration and mouth breathing, he could potentially have Impaired Oral mucous membrane.

A lot of 15-month olds are pretty active, but I'll bet he wasn't. How about Activity Intolerance?

What do you mean by "he was getting worse?" Do you mean the pneumonia was spreading, or was his breathing becoming more labored, other sx's worsening or new sx appearing? Depending on what 'worse' is, you might get some more ideas from that.

Did you interact with the parents? How were they dealing? Did the parents have adequate knowledge about the dx and tx? Were they anxious? That's another thing to consider with nursing diagnoses when dealing with pediatrics.

Hope this gives you some ideas and helps!