hpy2Bhere578

Hello!

I am in need of help:uhoh3:.

I am four weeks into second semester and we have a mind map due next week. We haven't been given much direction on how to do this. I have read a few articles but I am having a hard time.

My patient was admitted for pneumonia but was being discharged the day I recieved her as a patient. She had a hx of bronchial asthma, SOB, no previous surgeries but previous admissions due to recurrant pneumonia. Her vitals were T: 98.3, P: 75, R:18, BP: 138/70, SpO2 95% Room air, pain 2/10. She had an ABG but the results were not in her chart. She presented with expirtory wheezes bilaterally in the upper lobes. Diminished breath sounds in the R lower lobes. Increased labored breathing after conversations.

She did have allergies to PCN, levofloxacin.

Repiratory therapy came to give her a breathing treatment but she also used a ventolin inhaler twice during my shift. Otherwise I didn't give her any other medications. (We aren't doing I.V. meds yet). She had been on NS with 10mEq KCL @75ml/hr. Solu-Medrol had been given, Zithromax, Rocephin, K. that morning and Lovenox subcut the evening prior.

She didn't need any assistance with her ADL's. She was self-sufficient in all areas.

So, what I have decided after making a list of NANDAS is to focus on Ineffective airway clearance. We are required to have 3 NANDAS total. One biophysical, one psychsocial, one Knowlege Deficet. I would like to use pneumonia RF inhalers. And Ineffective Health Maintanence but I'm not sure if that is concidered a psychsocial NANDA.

Even after listing the above thread, I feel lost. Thanks for taking the time to read this and any thoughts or direction would be greatly appreciated! :bowingpur