Please help me with my concept map

[robinhood76]

Hi im first year Nursing student having difficulty with the concept map. My case study is like this:

Mr. P, 66 years old, calls to complain about shortness of breath and pain that started suddenly and feels like a knife. He states the pain gets worse with breathing. He is diaphoretic, and states he is having difficulty getting a full breath. On inspection, his left chest wall is not moving. His trachea is deviated to the right. On auscultation, he has no air entry. Vital signs T-36.6 P-100 RR-32 BP 100/70.

Although I figured out that the patient is suffering from Pneumothorax which is the chief medical Dx, I'm expected to come up with 4 Nursing Dx and also the Dx need to be " Actual problems" and not " Potential problems". After researching from books, i found out that Impaired gas exchange as the 1st Nrsg problem, Ineffective airway clearance as 2nd Nsrg Problem, Activity intolerance as 3rd Nrsg problem, Ineffective breathing pattern as the 4 th problem.

Iam very much worried that I might be not in the right tract as the 1st problem and 4th problem is very much similar .My concerns are am I ignoring that pain as one of the problem? but since pneumothorax is essentially a result of injury/trauma in pleural space . How can pain be Nursing problem? Im very confused and frustrated with this concept map. I would appreciate if anyone would help me to figure out the actual problems and Interventions.

[Daytonite, BSN, RN]

the patient's nursing problems are based on the symptoms the patient has. those symptoms should be listed on your concept map.

the patient's symptoms become the data, or evidence supporting any nursing problems:

• shortness of breath
  
• pain that feels like a knife
  
• pain gets worse with breathing
  
• diaphoretic
  
• having difficulty getting a full breath
  
• his left chest wall is not moving
  
• trachea is deviated to the right
  
• on auscultation, he has no air entry
  
• vital signs t-36.6 p-100 rr-32 bp 100/70.
  

each of these are evidence (defining characteristic) of a nursing problem (nursing diagnosis). your task is to figure out which one they belong to.

my concerns are am i ignoring that pain as one of the problem? but since pneumothorax is essentially a result of injury/trauma in pleural space . how can pain be nursing problem?

if you do not understand that "pain that feels like a knife" is a symptom of

acute pain

which is one of the nursing diagnoses and is a nursing problem i am a bit at a loss as to how to help you. look up "pain" in the index of your nursing textbooks and you will find lots of information on how it is a nursing problem and how we nurses do lots of things to treat it independently from what the physician's do for it.

see https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans for information on constructing a care plan.

[robinhood76]

Hello Daytonite,

Thanks for replying to my query, I get your point, but since Iam asked to make only 4 Nursing problems .My main concern is not whether pain should be considered as a Nrsg problem but whether the 4 diagnosis that I have already made is correct or not. If my findings is incorrect ,could you please tell me where I went wrong. I thank you for all the assistance in this regard.

[nurse_laura1984]

Hello there, I agree with daytonight. Pain should be considered as a nursing problem. The four diagnosis you have found are all relevent but the key here is prioritization. If I had a patient with the symptoms you mentioned above... I would be concerned with his immediate issues. While activity intolerence is an issue in the long run... without addressing his pain he wont be able to walk around anyway. Thus, pain must be addressed before activity intolerence can be considered.

I guess my answer is... prioritize, take away the activity intolerence and add pain control. This seems the most logical solution to me. Hope that helps.

[Daytonite, BSN, RN]

Impaired gas exchange and Ineffective breathing pattern are correct. Acute Pain is also a correct diagnosis. There is no evidence for Ineffective airway clearance and Activity intolerance so those are incorrect diagnoses. For your 4th diagnosis, you need to look up the complications of having a pneumothorax and a chest tube (the medical treatment for it).