Nursing Diagnosis Help

[dshermett]

I have a scenario that involves a 92 yr old woman who comes into the ER with decreased consciousness, low pulse-ox, crackling in lungs & RR of 24, coorifice & shallow. She is given O2, becomes more alert, diagnosed w/ pneumonia & put on antibiotics. 2 days later she can't walk very far w/o resting due to dyspnea and states that isn't normal for her.

The diagnosis I came up with is "Activity intolerance related to compromised oxygen transport system, secondary to pneumonia, as evidenced by being on oxygen therapy and still frequently needing to rest after walking short distances, dyspnea w/ light activity, and crackles heard throughout lung tissue."

I don't know if compromised oxygen transport system or impaired gas exchange is better or if I'm even on the right track.

[Daytonite, BSN, RN]

when you are diagnosing you need to consult a nursing diagnosis reference. if you have a copy of taber's cyclopedic medical dictionary you will find nursing diagnosis taxonomy information (definition, related factors, defining characteristics [signs and symptoms]) in the appendix. there is also taxonomy information for about 75 of the most commonly used nursing diagnoses listed on these two web sites:

• http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/
  
• http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm
  

diagnosing begins by sorting out the abnormal signs and symptoms that you picked out from the assessment you did of the patient. scenarios contain that information, so pull it out of the scenario (these are all the symptoms they have given you to work with):

• on admission, has pneumonia
  
  • decreased consciousness
    
  • low pulse-ox
    
  • crackling in lungs
    
  • rr of 24, coorifice & shallow
    

  [*]2 days later

  • she can't walk very far w/o resting due to dyspnea
    

next, you look through a nursing diagnosis reference for likely nursing diagnoses. every nursing diagnosis has a list of defining characteristics (signs and symptoms) and the patient must have one or more of them in order for you to be able to assign it to the patient.

• activity intolerance r/t imbalance between oxygen supply and demand aeb dyspnea upon walking
  

activity intolerance related to compromised oxygen transport system, secondary to pneumonia, as evidenced by being on oxygen therapy and still frequently needing to rest after walking short distances, dyspnea w/ light activity, and crackles heard throughout lung tissue.

this diagnosis has to do with the heart and lungs of the patient being unable to sustain activity. the person becomes fatigued or short of breath and exhibits heart and respiratory symptoms. the cause (etiology) of this problem are things like bed rest, deconditioning, being immobile for a while, overweight and those kinds of things. if the patient has a

compromised oxygen transport system

you are saying that the alveoli of their lung tissue is plugged up with pus and it is interfering with oxygen and carbon dioxide exchange. there is a diagnosis and etiology for that:

impaired gas exchange r/t ventilation perfusion imbalance

.

being on oxygen therapy

is a treatment and shouldn't be mentioned in the evidence.

crackles heard throughout lung tissue

is not a defining characteristic of this diagnosis. if i read the scenario correctly, i don't know that having crackles in the lungs even applies to the patient's assessment 2 days later. if it does, it belongs with a nursing problem such as

ineffective airway clearance

.

i don't know if compromised oxygen transport system or impaired gas exchange is better or if i'm even on the right track.

i have never heard of compromised oxygen transport and i have been doing care plans for many years.

impaired gas exchange

was present on admission. but it is now 2 days later and the only assessment data available is "she can't walk very far w/o resting due to dyspnea and states that isn't normal for her". that is

activity intolerance

.