Infection NANDA help please

[NurseNHowell]

So I'm a LVN doing my 2nd to last term (Critical Care) and am completely lost on what to do my nursing diagnosis for on this patient, which was due 15mins ago btw. Eek! Pt is terminal mesothelioma, so lung cancer and only 1 working lung. Has septicemia and necrotic lung mass, chest tube clamped and drained daily. Stopped chemo few weeks ago due to bone marrow suppression. So clearly not risk for infection or even risk for super infection, he's far beyond that. Sat'ing well at 98% on room air even with one lung. AOx4, perfusing well, has pancytopenia but is already extremely infected. Instructor said no risk for or pain nandas. Heres the possible for his Lung cancer

Ineff. tissue perfusion- nope perfusing well

Imbalanced nutrition- yeah but thats a weak main nanda for such an acute patient

Self-care deficit- weaker nanda

Risk for infection:superinfection- most likely already has

Activity intolerance- weak nanda

Fatigue- pretty much a given

Imp gas exchange- nope he's sating well with his PRBC transfusions

Ineff. breathing pattern- nope he's sating well even with his breathing pattern

So most are very week attempts when he clearly has more major issues and she completely shot mine out saying it should be something related to impaired or ineffective protection.

He does have poor intake but that can't be my main NANDA.

I can't seem to find anything on impaired protection... am I just completely missing something or am I just over thinking it and its right in front of my face but I can't see it?

And when will my autocorrect finally realize NANDAs does not need to be corrected to pandas? One is cute and cuddly while the other is far from cute and no where near cuddly

Thank you for any help you can direct me in

[203bravo, MSN, APRN]

you have not really listed much by the way of assessment so I really can't be of much help in assisting with an actual nursing diagnosis. But I can offer 1 piece of insight -- you keep insisting that the patient is perfusing well because the SpO2 is staying high on room air.. I caution you against this line of thinking because SpO2 only measures the amount of oxygen that is being on transported on the red blood cells that are present.. you must check the patient's H&H since they have a known history of pancytopenia and is receiving transfusions... If the H&H is still low the patient could very possibly not be perfusing well even though the O2 stat reading may be 100%.. there may simply not be enough RBCs to carry enough O2. You would need to check other signs and symptoms of perfusion to confirm adequate perfusion.

[nursej22, MSN, RN]

Yes, it's difficult to form a diagnosis without an assessment. Otherwise, I think you may be looking for ineffective protection . Any psych/social components?