picking nursing diagnosis- help! interesting patient

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I had a patient last week who came in with DVT and then suffered from a rectus sheath hematoma (bleed in the abdominal wall due to coumidin)

patient has COPD, Diabetes, hypertension, depression

was placed on bed rest upon CT scan of hematoma and received 2 units of packed red blood cells

I have come up with the following nursing diagnosis:

decreased cardiac output related to abdominal bleed AEB to drop in blood pressure from baseline

ineffective tissue perfusion related to hypovolemia AEB abdominal pain and tenderness

Acute pain r/t adominal bleed AEB patient complaints of severe pain

ineffective tissue perfusion related to interruption of venous flow AEB edema of lower extremeties

acute pain related to inflammation of lower extremeties AEB patient complaints

risk for constipation related to insufficient physical mobility

risk for impaired skin integrity related to bed rest

risk for infection related to alteration in circulation

I am sure there HAS to be many more NG for this patient but I just can't seem to come up with more, and do these make sense?

thanks!

I think it is just more complicated because he came in with one thing, the DVT and totally switched directions with this hematoma-:o

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Specializes in med/surg, telemetry, IV therapy, mgmt.

did you go through the steps of the nursing process starting with assessment first? assessment includes evaluation of the patient's ability to accomplish their adls (activities of daily living). how is he getting his bathing, dressing, mobility, eating, toileting, and grooming accomplished? how is he getting his adls done, particularly one's involving mobility (he's on bedrest, isn't he?) this patient has copd, diabetes, hypertension, and depression and i'm betting is on medication for all of them. i saw no nursing diagnoses that are associated with the copd, diabetes, hypertension, or depression. he is also having a complication from the coumadin he was on for his dvt (risk for injury r/t altered clotting factors - risk for injury). with his copd and coughing, do you think he is at risk for bleeding into his lung and potentially developing a hemothorax? i would be. how has this bleed into his abdomen affected his diet and his diabetes? how's his depression doing with these developments?

there are problems with your diagnostic statements:

decreased cardiac output related to abdominal bleed aeb to drop in blood pressure from baseline

"
abdominal bleed
"is not an acceptable related factor for this diagnosis. the cause (etiology) has to be something related to cardiac output. i get what you are after: altered blood volume. why don't you just say that? and, instead of saying "
drop in blood pressure from baseline
" why not just cut your wording down to "hypotension of ___" and list the blood pressure. however, this man has hypertension and copd. is this hypotension temporary and only due to the anemia? was it corrected after receiving the 2 units of blood? anemia is more of a
deficient fluid volume
problem.

ineffective tissue perfusion related to hypovolemia aeb abdominal pain and tenderness

the organ (site) where the tissue perfusion is faulty must be specified in the label. if it is in the abdomen, the it is
ineffective tissue perfusion, gastrointestinal
.

acute pain r/t abdominal bleed aeb patient complaints of severe pain

where is the pain? the abdomen? what is the cause of the pain? how can abdominal bleeding be causing pain? pain must be due to injury of some sort. look for inflammation as a source of the injury with a dvt and any kind of swelling that is going on. do you have anything more specific than "
patient complaints of severe pain
"?

ineffective tissue perfusion related to interruption of venous flow aeb edema of lower extremities

this is the same diagnosis that you have above (
ineffective tissue perfusion related to hypovolemia aeb abdominal pain and tenderness
) and they can be combined into one statement. again, you must specify where the tissue perfusion is faulty:
peripheral.

acute pain related to inflammation of lower extremities aeb patient complaints

this is the same diagnosis that you have above (
acute pain r/t abdominal bleed aeb patient complaints of severe pain
) and is, in fact, more correct with the related factor. your aeb proof is really vague.

risk for constipation related to insufficient physical mobility

risk for impaired skin integrity related to bed rest

related to physical immobilization due to bed rest

risk for infection related to alteration in circulation

how does altered circulation result in a risk for infection?

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