Need Help!!!

AgentBeast, BSN, RN · Apr 25, 2012

You can't really say someone has a low hgb level just because they have chest pain can you? You'll probably want some supporting lab work, along with other signs/symptoms someone is having decreased cardiac tissue perfusion.

Esme12, ASN, BSN, RN · Apr 25, 2012

welcome to the largest online nursing community! this might be better served in the student section under nursing student assistance.

what semester are you? it seems that you have picked your diagnosis and are trying to fit your patient into it when the exact opposite is true.

make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first. you need to know the pathophysiology of your disease process. you need to assess your patient, collect data then find a diagnosis. let the patient data drive the diagnosis. what is your assessment? is the patient having pain? why are they having pain? is the cardiac pain? or musculoskeletal pain? are they having difficulty with adls? what teaching do they need? what does the patient say? what are the labs? what does the patient need? what is the most important to them now? what are the comorbidities?

how do you know the chest pain is caused by a low hgb and not blockages in the arteries if the pain is cardiac in nature? what is cardiac chest pain? what causes it? we need more information before we can help you.

the medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. it is trying to teach you how to think like a nurse. think of them as a recipe to caring for your patient. your plan of how you are going to care for them.

from a very wise an contributor daytonite.......

every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the nanda taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what nanda calls defining characteristics.

here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: in order.

assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

a dear an contributor daytonite always had the best advice.......check out this link.

https://allnurses.com/nursing-student...is-290260.html

you need a good care plan book. i prefer gulanick: nursing care plans, 7th edition. they have an online care plan constructor. it used to be free but they caught on so now you need to buy the book to use the constructor.

care plans must be chosen from the "approved" script....nanda. i think the biggest mistake students make is that the need to let what the patient says, does and feels (the assessment) dictate what you do next. not the medical diagnosis and try to fit the patient into diagnosis.

what information do you have so far?

rn/writer, RN · Apr 25, 2012

Moved to Nursing Student Assistance forum.

guest042302019, BSN, RN · Apr 25, 2012

Hello everyone, I new to this site. I wanted to know if this diagnosis was ok; Ineffective tissue perfusion (cardiac) r/t decreased hemoglobin concentration in blood aeb Chest pain.

There is a couple things I would look at.

First, this is a "risk for" diagnosis and you've got the wording jumbled a bit. Skip the parentheses. You would write as Risk for decreased cardiac tissue perfusion r/t...

Second, a "risk for" diagnosis doesn't have evidence. It hasn't happened yet. But, you've determined risk factors. What are they?

The definition of this diagnosis is "Risk for a decrease in cardiac (coronary) circulation. What is circulation (perfusion) mean? Generally, perfusion refers to the liquid portion of the blood getting to an organ. Therefore, the blood volume reaching the organ is a main concern. What risk factors have you identified that would prevent the blood volume to reach the heart? If you have none, check your diagnosis book for them. If you don't see any, skip the diagnosis and find another one.

Now, consider what hemoglobin is. It's a protein. Where do we get protein? Our diet. Many times a hemoglobin problem is a nutrition problem. What's your patient's diet like? But, also, low hemoglobin can be attributed to cancers, renal problems, or anemia. Also, low hemoglobin goes hand in hand with low hematocrit. Was that low as well?

Some other diagnoses to consider are fatigue, imbalanced nutrition, risk for injury and others. But, first. What does your assessment findings tell you. What is the patient medical history? What else did you notice in your physical assessment? What are other lab values? And, what did diagnostic tests reveal? I think when you consider all of those assessment findings your diagnoses will be more appropriate and well rounded.

nurseprnRN, BSN, RN · Apr 26, 2012

"hello everyone, i new to this site. i wanted to know if this diagnosis was ok; ineffective tissue perfusion (cardiac) r/t decreased hemoglobin concentration in blood aeb chest pain. "

i'm the champion of insisting on data first, diagnosis and treatment plan second, and you don't tell us what data you have to make that diagnosis. that said, you could certainly say that someone can be having chest pain because his hemoglobin is too low resulting in decreased oxygen-carrying capacity (i am assuming that you actually have a lab report with a low hemoglobin), so on that basis the diagnosis, defining characteristics (chest pain, and you ought to also look at ekg signs of ischemia) are just fine. he could have a low h&h from any cause-- trauma, malnutrition, cachexia from whatever cause, myelosuppression... there's nothing wrong with this diagnosis if you do, in fact, have evidence to support it. (if you don't all bets are off.)

translating the nanda-i language into plain english, what you would then have is, "my patient has chest pain because he has inadequate oxygen-carrying capacity. i know this because his hemoglobin is (whatever low value you have) from (whatever), and he has ischemic changes on his ekg (assuming he does) with his reported pain." if you have information on the condition of his coronary arteries (like a cardiac cath showing poor flow), so much the better.

you can even look at spo2 and hct/hemoglobin. someone with a spo2 of 95% and a crit of 20 is delivering half as much oxygen to the cells as someone with a spo2 of 95% and a crit of 40. look at the big picture.