Primary v.s. Secondary Diagnosis?

[livelovenursing]

I am having a difficult time deciphering between the primary v.s. the secondary diagnosis. The case study says that the patient is in the hospital "status post lung transplant secondary to pulmonary fibrosis." Is the primary diagnosis the fact that they are lung transplanted, or is it the pulmonary fibrosis? If someone could please explain to me as I am a bit confused. Thanks in advance!

[Hannahbanana, BSN, MSN]

This is why I mentioned overlap. Of course nurses have to know a lot about physiology, medical diagnostics, and medical conditions.

The point of nursing diagnosis is to make a decision based on nursing assessment and treat it as a nurse would. These are not mutually exclusive. In the example you give, the medical dx of pneumonia, the nurse is legally obligated to implement parts of the medical plan of care, such as giving prescribed medications and treatments required to be RX'd by a licensed provider (MD, DO, NP, etc.).

In most places the unit clerk is responsible for seeing that the CXR gets scheduled and done as part of the medical plan of assessment and care. The nurse would be responsible for seeing that the report is forthcoming.

Nursing's diagnosis of ineffective airway clearance (if that's what's happening c this pt) would prompt nursing to institute NURSING measures as appropriate, like raised head of the bed, C&DB q 1-2 hrs, hydration, and continued monitoring for changes in sputum, SOB, SpO2, etc.  The nurse would likely also assess for activity tolerance (SOB, SpO2 changes at what level of activity?) and modify activity appropriately. What other things might a nurse do for a pt c ineffective airway clearance, activity intolerance, and whatever else you see in this pt? Teach about meds, teach about reporting sx/sx like changes in SOB, sputum color, or pain, teach about smoking cessation, family support, ask about whether there's mold or other known risk factors in the home, ask those four important questions before discharge (who lives c you? Who shops and cooks? How many stairs do you have to climb to get him? How will you get your meds and f/u care?-- all shown to have significant effects on readmissions) ....

NONE of this requires MD input. This is, explicitly, what the nursing practice act in our state requires you to do: Make an independent nursing assessment, derive a nursing plan of care, implement it/delegate it, evaluate it, and adjust it PRN.

This is why health insurance pays for hospitalization-- for NURSING care in addition to the provision of medical care.

And again, the EHR/EMR is catalogued by medical diagnosis solely for the purposes of financial reimbursement. That doesn't mean nursing assessment and diagnosis based on it never appears in a chart. On the contrary, I have seen a number of legal cases where lack thereof was a critical factor. Think like a nurse, because that's the standard to which you will be held.

[LubbDubb77, BSN, RN]

On 2/16/2021 at 11:39 AM, fibroblast said:

This being used as a diagnosis, admitting or primary, I'm not sure it would even be considered as an acceptable diagnosis IRL. Pneumonia or CF sure, but all these other nursing handbook diagnosis, I've never seen them being used or acceptable for an admitting or primary diagnosis, they would be flagged as unbillable or 'not acceptable'. 

I guess dx's like impaired skin integrity and ineffective airway clearance is what nursing school is focused on. 

 

Not sure why my reply has a quote attached.  My previous reply may have been confusing, I apologize. I wasn't directly giving an example from what the student had provided. I was giving a generalized statement.