I swear I can do a nursing diagnosis!

[Amber101688]

This is in no way me wanting people to feed me a care plan, I'm just frustrated. I'm working on my *knock on wood* last care plan which is a case study due to an upcoming trip to visit my family. I know i can devise my plan to finish it but my nursing diagnosis is leaving me baffled. Its about an 84 yo woman with a history of smoking, COPD, HTN, high cholesterol, anxiety. She's presenting in the ER with dyspnea, intercostal retractions, bilateral minimal air movement, scattered wheezes, temp and low O2 sat. She's already been dx with pneumonia and started on Predisone and Zithromycin 3 days prior. She came in due to worsening SOB, fever, cough and pain with deep insp. Her labs indicate respiratory acidosis with compensation. Her wbc is 3.0 and other labs indicate continued bacteria presence. After the first blood culture she's started on Ampicillin. My priority dx was obviously impaired gas exchange. I'm reluctant to use ineffective airway because she's effectively coughing up secretions and no mentioned airway issues. Her pain was minimal and then after initial interventions her oxygenation status, ventilation quality, pain (none now) etc have all improved. So I don't know if I'm just an idiot but I assume ineffective protection is an issue. I was looking around though and EVERYTHING is *risk for* infection. (Or a list of other choices, but never ineffective protection) I know in the past I've followed suit with risk for and my instructors have accepted it because my interventions and rational were satisfactory but they preferred ineffective protection not risk. So what am I missing??? Why is it not addressed as present infection that needs to be treated, instead it's a risk for?

Sorry for for the rant! Just want to make sure I leave these evil care plans behind me on a strong note!

[Scottishtape]

I'm not sure I'm completely getting what you're saying, but here are my thoughts based on what I think I understand from your post...

Pt has COPD, so impaired gas exchange is always going to be a priority dx for her, so you're right on there.

Ineffective airway clearance would be an appropriate risk dx because with her hx of COPD, plus the fact that her work of breathing has become even worse r/t the pneumonia, she can end up with fatigue, thus leading to the possibility of ineffective airway clearance. This is important to identify and plan care for.

That would be a higher priority than treating the present infection because ineffective airway clearance would kill your patient well before an infection.

So, the "Risk for" dx should come before the infection.

Thats how I understand the situation, but I'm definitely interested in hearing others' opinions as well.

Good luck!

[Amber101688]

After posting this I stepped back for a few and when I got back at it I ended up coming to about the same conclusions! I think I was just over thinking it, ha! í ½í¸… I appreciate your response (and reassurance of like reasoning) so much!