nursing diagnosis need help

[deanikins211]

my instructor told me to revise my ncp. my pt's chief complaint is productive cough and his impression is pneumonia. I already made a potential problem and that is Loss of appetite and my diagnosis is

risk for imbalanced nutrition; less than body requirments related to increased amount of mucus secretions. I know my nusing diagnosis is inappropriate but I really need your help guys on how to correct this diagnosis. This is my first time and I'm out of idea....thank you.

[Daytonite, BSN, RN]

1)thank you. but why is it that in nanda books there is imbalanced nutrition:risk for more than body requirments but there is no imbalanced nutrition:risk for less than body requirments..sorry if i keep on asking questions. i just want to make things clear. i appreciate you help a lot....

if you do not ask questions, how will you know these things? i am not upset by the questions. the questions help me understand where you are in your understanding and thinking. this stuff is not that easy to learn at first.

i just explained that to you above in my last post. a patient will dehydrate and die before they will starve and lose weight when they do not eat and drink. so, if you have someone who is

imbalanced nutrition: risk for less than body requirements

their primary problem is going to be dehydration which should be diagnosed as

risk for deficient fluid volume

rather than using

imbalanced nutrition: risk for less than body requirements

. by the time the patient is at a

risk for imbalanced nutrition: less than body requirements

, that problem is well underway and the patient is most likely experiencing

adult failure to thrive

. you have to know physical assessment skills and be performing them on the patient to know these things. you also have to know the definitions and defining characteristics of these diagnoses when using them. that's why you need to be referring to the taxonomy information.

2) back to my patient, he may go home anytime, he still have ocassional cough ,not afebrile , not dyspneic in fact he looks healthier than me. my problem is that i still have to make 1 potential problem (i already done with the risk for fluid volume deficit) . isnt it hard to find a potential problem for that kind of patient? how about risk for impaired gas exchange? his impression is pneumonia but it doest show a positive result.

my point is this. . .diagnosing (determining his problems) is based on your examination of his physical condition and ability to care for himself. potential, or anticipated, problems are things that are

likely

to happen. so, you need to know the normal course of a disease (pneumonia in this case), the possible complications that can happen when a patient gets pneumonia and even the side effects of the treatments for the condition that the patient might suffer. the point of "risk for" nursing diagnoses is to attempt to prevent them from happening and/or monitor for the symptoms of those conditions and institute treatment for them immediately upon their appearance.

i was waiting for you to bring up

impaired gas exchange

as an actual problem in this patient. the reason is that it goes to the pathophysiology of the pneumonia. because patients with pneumonia have an inflammatory process going on in the cells of their lungs, their alveoli are usually congested with pus along with all the mucus. their chest x-rays show a consolidation process going on. this causes an interference in the exchange between oxygen and carbon dioxide in the capillaries of the alveoli. thus, you will have noticed the patient having shortness of breath, perhaps some nasal flaring as they try to breathe, sweating as they work to breathe and if blood gasses were done they are going to show low oxygen concentrations and high carbon dioxide concentrations. their nursing diagnosis for this is

impaired gas exchange related to ventilation perfusion imbalance

.

i would ask you that if your patient is already coughing productively, where is this sputum originating? is this patient already on supplemental oxygen? the reason i ask is because the definition of

impaired gas exchange

is

excess or deficit in oxygenation and/or carbon dioxide elimination

at the alveolar-capillary membrane

(pg. 94,

nanda-i nursing diagnoses: definitions & classification 2007-2008

).

the two potential problems for this patient are

1. risk for deficient fluid volume r/t inability to drink enough fluids accompanied by excessive fluid losses through sweating and the respiratory tract
   
2. risk for infection r/t suppression of inflammatory response [this happens when antibiotics are given and a secondary infection has an opportunity to take over, move into other organs or the bloodstream and becomes septic putting the body at great risk. a patient on antibiotics is always at risk of another opportunistic infection appearing somewhere else in another organ system of their body.]

[l_wheat]

Look in your Dx book and try to think of the worst case scenario, those are the ones that you REALLY REALLY need to pay attention to, prioritize all of the Dx's that are in the book, ABC's, ABC's, ABC's. Good Luck. L

[nhie baby maanne]

i also had the same dilemma as yours..lol.