Nursing Diagnosis evaluation

[echo2112]

I have a pt that has been in facility since 9/12 for a wound infection sp CABG on 08/16. Discharged 09/07 after treatment for wound infx. Came back on 09/12 for SOB, chest pain, and S/S of infx at wound site. Was also diagnosed with bacteremia and osteomyelitis of the sternum at that time. Due to his financial situation with the VA he can't get home health care, so he is stuck in our facility until at least 10/17. Hx includes CAD, DM(type 2 non insulin dependent), HTN, Anemia (chronic, unspecified), hypercholesterolemia.

So I am looking at 3 nursing dx based on Maslow. Infection (Risk for) comes to mind, even though it strikes me odd that there is not a risk, since he most certainly has an infection. But infection is a medical diagnosis, so my understanding is that risk for is what would be used for the nursing dx.

His labs are normal, except for WBC, HgB and HcT, all lower values.

With the lowered HgB value and anemia, I was thinking that impaired tissue perfusion due to reduced O2 carrying capacity would be a good choice, but his SPO2 sats were above 90 on room air.

Unsure of the third. I figured that the DM would be important, as it ties to wound healing and immune system, so there is impaired tissue perfusion (renal) but I am not sure if that is really accurate, as his BUN and creatinine labs are normal. There could be something there for inadequate nutrition, both from the DM and the fact that he has been on antibiotics for a month, which is impacting his normal flora in the gut.

Or should I look at the CAD and HTN? I am trying to focus on what I did to treat the patient in the clinical setting - IV antibiotics, wound care, assessment. Impaired gas exchange ties in with tissue perfusion due to the CAD and DM, would that be a good choice?

Any help or comments would be greatly appreciated!

[BellsRNBSN]

Wow that's tough. I agree that you should avoid the Risk for Infection diagnosis, because it's more of an actual infection versus a risk for, at this point. What about a nursing diagnosis of "Risk for a decrease in cardiac (coronary) circulation"? Risk factors for this diagnosis related to your patient include: cardiac surgery, hypertension, diabetes mellitus, and hyperlipidemia. Also, one of the patient specific outcomes listed in my textbook is that the patient will be free from chest pain related to angina, which your patient appears to have...unless the chest pain is related to the infection and is not angina. Just a thought!

Good luck with your care plan!