Nursing care plan diagnosis for risk of fat embolism

[laleach3]

I hope I am posting this in the correct area. If not, I apologize.

I am working on my first nursing care plan and I need to include the risk for fat embolism. Of course, NANDA doesn't list anything about a fat embolism, so I am trying to come up with something that relates. I have been sitting her driving myself insane for about 5 hours and I still have no idea where to place it.

My first thought was to list it as: Risk for peripheral neurovascular dysfunction. Then I thought it might fit better under Risk for ineffective airway clearance (this just doesn't feel right). I am ready to go play in the highway and would appreciate anyone's advice.

[jrkingRN]

I thought "Increased Risk of Fat Embolism" was one...how about risk for ineffective air exchange?

[jrkingRN]

Or how about risk for ineffective tissue perfusion?

[laleach3]

Hmm... impaired gas exchange looks like it could work... are you certain this is the one to use?

[jrkingRN]

Because there are so many things that could happen with a fat embolism, I can see why it's hard to pick just one...

[laleach3]

I was looking at the tissue perfusion one too. I feel like maybe several could apply, but I wonder if there is a specific one that should be used. I am using this as my number 1 diagnosis and I'm just not confident with any of them.

[jrkingRN]

Tell me more about the patient, maybe I can help you out...

[laleach3]

Thank you!

My patient also has diabetes mellitus and atrial fibrillation which I think is making the selections a little more difficult. He is a 54 year old man who sustained multiple fractures and dislocated his shoulder after becoming dizzy and falling.

He does have a lot of pain (even fractured his zygomatic arch) but I felt monitoring him for a possible fat embolism should take priority and then address his pain?

[jrkingRN]

Well you hit the jackpot!

If I had a patient with a history of Afib that fell I would DEFINITELY be thinking about afib's tendency to cause blood clots. And then maybe that blood clot traveled to his brain and made him dizzy, (impaired gas exchange!)which made him fall...

If you have one of those instructors that only lets you do a care plan based on their admitting diagnosis (which is stupid) this is what i would do-

1. Acute Pain

2. Risk for Ineffective Tissue Perfusion (definitely mention AFIB, and fat embolism here)

3. Impaired physical mobility

Is the patient on Coumadin for his afib? If he is then you could always throw in Risk for further injury because if he falls again (because of the impaired mobility) he could bleed to death from the coumadin use.

[laleach3]

I can't believe how easy you just made that seem! Thank you so very much. That makes perfect sense. I was going round and round in a circle of doom. He is on the Coumadin and now I feel like there is hope for me to wrap this thing up.

[jrkingRN]

Anytime...Now that I'm a nurse, care plans seem so obvious. And I LOVE to help with them :)