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Please Help!!!

Nurses   (4,786 Views 8 Comments)
by TruDivaRN TruDivaRN, BSN, RN (Member)

TruDivaRN is a BSN, RN and specializes in Long Term Care.

3,530 Profile Views; 119 Posts

i had my clinical instructor review my careplan for my client who had an mi on the 25th. she told me that ineffective tissue perfusion and decreased cardiac output where the same nursing dx:uhoh3:. ineffective tissue perfusion is my primary nursing dx. i was thinking of replacing decreased cardiac output with impaired gas exchange. my question is should i make the impaired gas exchange my primary:confused: ??

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2 Posts; 421 Profile Views

I was awful at the care plans so I don't know how helpful I will be but here goes:

I would make decreased cardiac output the primary since it's the most directly related to the MI. I would say that the Tissue Perfusion issue is a result of the decreased cardiac output, so I wouldn't think it would be necessary to mention it. I guess that's what your teacher meant...They're not really the same thing but they both have the same effects on the body, so there's not much sense in mentioning it twice.

Or...maybe you could say Decreased Tissue Perfusion related to decreased cardiac output secondary to MI.

I don't know if that would fly or not. Good luck.

Just get a good care plan book.

One for MI is probably in there. : )

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18 Posts; 1,313 Profile Views

You can also use other diagnosis such as risk for second mi as many people who have one will have another this can then lead you to help the person change their lifestyle exercise and diet changes to improve their chances of having a second mi

you could also use risk for diabetes as many people who have mi have underlying diabetes, has your patient been tested? if he does have diabetes then that opens up a whole realm of lifestyle changes you can help him with and a whole bunch of complications that you can help him prevent

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loricatus specializes in ED, ICU, PACU.

1,446 Posts; 13,033 Profile Views

i had my clinical instructor review my careplan for my client who had an mi on the 25th. she told me that ineffective tissue perfusion and decreased cardiac output where the same nursing dx:uhoh3:. ineffective tissue perfusion is my primary nursing dx. i was thinking of replacing decreased cardiac output with impaired gas exchange. my question is should i make the impaired gas exchange my primary:confused: ??

i think your clinical instructor better go back to school. ineffective tissue perfusion relates to the cellular process, which would be influenced by decreased cardiac output; but, is not exclusively caused by it. other factors that cause ineffective tissue perfusion would be shock states (of that cardiac shock is only one of the shock states)-therefore, the 2 diagnosis are not the same. looking at it another way-if cardiac output were to increase, you may just have a resulting increased tissue perfusion; but, not always (eg, hypovolemia). if the 2 were the same, you would see them parallel with interventions (which they do not always do).

impaired gas exchange would be appropriate if the patient has pulmonary edema r/t the decreased cardiac output-but, then again, your instructor might try to say that the diagnoses were the same. if you have a nursing diagnosis book, take a look and show her that related diagnosis are just that. a medical condition may result in more that one nursing diagnosis, which does not necessarily make them the same.

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1,842 Posts; 28,337 Profile Views

not sure if this'll help, but this is the care plan included

in my manual for a patient who has had an MI:

1. Alteration in tissue perfusion related to imbalance between myocardian

oxygen supply and demand.

2. Pain related to imbalance between myocardial oxygen supply and

demand.

3. Activity intolerance related to imbalance between myocardial oxygen

supply and demand.

4. Disturbance in self-concept related to possible changes in role,

vocation, and lifestyle.

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gt4everpn is a BSN, RN and specializes in Licensed Practical Nurse.

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ineffective tissue perfusion and decreased cardiac output are not the same diagnosis. don't worry you were right, some of these instructors swear they know what they're talking about, and sadly they don't. how could she/he say that they are the same. decreased cardiac output would be my first choice, then ineffective t.p. impaired gas exchange would be low on the list, seeing that m.i is a cardiac problem, not pulmonary. you're right not to fear!;)

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Daytonite is a BSN, RN and specializes in med/surg, telemetry, IV therapy, mgmt.

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there is no way that anyone can answer your question for you. the selection of a nursing diagnosis is not necessarily dependent on the medical diagnosis. it is dependent on the symptoms that the patient is having, not upon their medical diagnosis. the medical diagnosis can only point you in the direct of possible nursing diagnoses that you could use. this saves you time in looking for nursing diagnoses to go with your patient's symptoms if you are not familiar with the definitions and symptoms of the various nursing diagnoses. however, the patient still has to have the symptoms that match with that nursing diagnosis. you haven't mentioned one symptom that your patient has so there is no way to evaluate whether or not your choice of nursing diagnoses is correct.

the first step in care planning is to make a thorough assessment of your patient and pull out the list of all your abnormal findings. those abnormal findings, or symptoms, become the basis that support any nursing diagnoses you choose. as a student, you need to use a nursing diagnosis book as a reference to do this. just like a medical diagnosis has a list of symptoms associated with it, each nursing diagnosis also has a list of symptoms associated with it. these will be listed in a nursing diagnosis book.

i explain these concepts in posts all the time, usually on the nursing student assistance and general nursing student discussion forums. please post questions about nursing diagnoses or care plans there where i can find them. there are also two threads in these forums that repeat a lot of the things i put into posts on nursing diagnosis and care plans. you might find it helpful to review the information in them.

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crissrn27 is a RN and specializes in nursery, L and D.

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Take it from a former careplan nurse.............decreased cardiac output and decreased tissue perfusion are not the same dx. Decreased cardiac output might increase the problem of decreased tissue perfusion, but its not the same. That being said, while we can come up with some generic dx that a person with MI might have, without further info we can't tell you which ones to use.

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