Need help with nursing diagnosis for a grand round presentation

[Natalie Cortelloni]

hi! i need help with a nursing diagnosis for a grand round presentation. i have to have 2 nursing dx for this; i have one already:

impaired gas exchange r/t immobility secondary to back injury, surgery aeb hgb of 7.4, rbcs of 2.49, on bedrest, and hypoactive bowel sounds.

i took care of a 39 yo male with a back injury for main admitting dx, but was crushed by a boulder in a mine, so the other injuries are: left ankle and femur fx, rib fx, pelvic fx, fx of lumbar vertebra and injury of celiac or mesenteric artery. he also had an ng tube on the first day i had him, but we took it out in the morning the next day. he had incisions closed with staples on his left knee, left hip, right hip/sacral area, and the left thigh area. on the first day his labs were: bun-27, triglycerides- 161, co2- 34, ca- 7.3, rbc- 2.55, hgb- 7.6, hct- 23.4; 2nd day: glucose- 139, bun- 23, cl- 109, ca- 7.8, albumin- 2.8, ast- 66, alt- 90, protime- 11.5 sec, rbc- 2.49, hgb- 7.4, hct- 22.3, prealbumin- 11.1. on that 2nd day, we had to give him 2 units of blood. i've looked at fluid volume deficit, risk for injury, risk for bleeding, but to me, none of them really fit. and i'm not sure if i can take the risk for off and use just bleeding for the diagnosis. anyone please give suggestions, i am not very good at these at all.

[dudette10, MSN, RN]

I'm just a student, but I'm not seeing the impaired gas exchange.

If you've been crushed by a boulder, had surgery for multiple broken bones, what is the very first nursing diagnosis that comes to mind? With someone who has multiple incisions on his body and is probably not moving much, there are second and third nursing diagnoses that jumps out at me, too.

Before you rule out fluid volume deficit, did you collect info on his vitals and I/Os?

[Natalie Cortelloni]

I believe I was going to write that down and I remember looking at the I&O, but at clinical I was pressed for time and must've forgot to write it down. I am working on time management right now, since we are taking care of 3 patients at the moment. But now that I look at the impaired gas exchange, I see what you're saying. I do have v/s for both days, though.