Nursing dx'es question/help please

[83sunshine]

Hey all,

I am confused as to which nursing diagnosis to use for my care plan. My patient has CHF and pleural effusion. The patient had shallow respirations, labored breathing, dyspnea (especially upon exertion), orthopnea, oxygen sats at 93-96% on 2L via nasal cannula, tachypnea (her resp. rate was erratic and reached up to 31 resp. per min. at times). The patient also had diminished breath sounds in left lower lobe of lungs. I cannot decide whether to use ineffective breathing pattern or impaired gas exchange. I also plan on using decreased cardiac output and activity intolerance. Any advice would be greatly appreciated!

Thanks!

[xtxrn, ASN, RN]

Why not use both? You can address 2 similar issues on the same patient :)

[83sunshine]

Unfortunately our instructor is very against us using more than one diagnosis from each category on our care plans. Sigh. Otherwise I absolutely would. I think I am just going to use ineffective airway clearance instead. Thank you for your reply though :)

[nurseprnRN, BSN, RN]

in my opinion, you can and should use both, because they are different issues even though they both involve the lungs. make a case for that with your instructor, because of the following:

ineffective airway clearance is a mechanical thing, related to the mechanics of breathing and/or the ability to clear the airway of obstruction (by coughing, suctioning or physically opening an airway in someone who can't do that himself) or inability to expand the lungs (like postop pain, an effusion which takes up space in the chest, or abdominal distension (bet her liver is enlarged, too) ) or diaphragmatic weakness (caused by neuromuscular disease, exhaustion, or decreased circulation and issue oxygenation to that big muscle), for example.

ineffective gas exchange occurs at the alveolar level, in this case related to the edema which is getting in the way of efficient gas exchange in the capillaries there. this is caused by the heart failure.