Nursing Diagnosis Question

[studentnursebrandie]

I am currently working on a care plan and I am having a hard time deciding on a nursing diagnosis. My question is: Can I combine 2 nursing diagnosis to create a care plan? For example: Ineffective Airway clearance and Breathing Pattern r/t increased mucous production and inflammation secondary to pneumonia and asthma. I was going to separate the two, but I felt like they were so similar that it would be redundant to create two separate care plans. Is it acceptable to combine the two, or would I need to keep them separate as they are listed on the NANDA list?

Thanks for any help!

nursingstudentbrandie

[sara_ky]

In my classes, we were taught to use one nursing Dx per care plan.

I checked my Nurses' Pocket Guide, and it defines "ineffective airway clearance" as the "inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway." To me, that primarily involves the physical/mechanical components of breathing. For example, the bronchioles are being affected by increased mucous secretions. The pt's nose is too congested to allow for effective breathing. The pt's HOB isn't elevated enough to help physically facilitate better respirations. That sort of thing.

"Breathing pattern" is ventilation itself, the rate/depth/rhythm of respirations. From the Pocket Guide, "breathing pattern - ineffective" is defined as: "inspiration and/or exhalation that does not provide adequate ventilation."

Both are definitely affected by the increased mucous production and inflammation secondary to pneumonia and asthma you described but in this case. Both have impaired gas exchange as potential secondary dx. Which need do you think is most immediate and can be best/most expeditiously addressed by nursing interventions?

You can definitely takes some quick actions, such as elevating the pt's HOB, increasing pt's fluid intake, etc., that would address "ineffective airway clearance" by helping to clear some of those secretions effectively, so personally, I'd pick that one as my priority. Good luck!

[RNTutor, BSN, RN]

I agree, the 2 dx should definitely stay separate.

It can be a little confusing to see the differences though, because several of the nursing interventions could address both dx at the same time. For example, encouraging deep breathing would help with airway clearance by expanding the lungs/aveoli and preventing fluid/mucus build-up on the aveoli. Deep breathing also helps with ineffective breathing pattern if pt had been breathing too shallowly due to, say, chest pain from the pneumonia or something.