Nursing Diagnosis Help- Respiratory problem and Post op colostomy

[novagirl123]

I am having a lot of difficuly defining my nursing diagnoses for my patient. Wondering if anyone can assist me in figuring out my three priority diagnoses.

Patient is post op colostomy. Age 72.

Hx: COPD, smoker for 63 years!!, arthritis- chronic pain, and a long history of bowel problems leading to colostomy.

She's been coughing, with a small amount of grey expectorant, she feels slightly short of breath at rest and weak upon activity. Chest assessment finds decreased air entry and very noisy expirations, perhaps due to secretions. At times she has low room air oximetry readings (88 %) which nasal oxygen bring up to 94%. She is in pain due to chronic (hip and back) and acute (surgery, GERD) conditions. She is experiencing nausea. Her pain is causing her to be resistant to mobility, which is turn is decreasing her ability to cough up secretions. She has very minimal WBC increases, which may be attributed to surgery. She is on a clear fluid diet and has not eaten much in 3 days. She has IV NS going at 150ml an hour.

I have no chest x-ray results, no ABG's and as a smoker she may have lower pulse oximetry readings naturally. It does not appear to be pneumonia. Should my nursing #1 diagnosis be Impaired air exchange or Ineffective airway clearance or Activity intolerance? or something different althogether.

And what about my 2nd and 3rd diagnoses: Acute or Chronic Pain (difficult to deal with because she has 3 sources of pain- surgery, arthritsis and GERD), and Nutrition imbalance: less than body requirements??? Dealing with the colostomy (learning needs, self care) at this point is further down the line.

Thank you