Priority nursing diagnosis (hemothorax)

[lookingabove313]

My patient has a hemothorax due to a gunshot wound. These are my three ND and I need to know if I have them in the right priority. thanks!

IMPAIRED GAS EXCHANGE r/t ventilation-perfusion imbalance aeb blood carbon dioxide level of 55.

ACUTE PAIN r/t recent injury aeb patient report of pain being a 7 on a 7-10 pain scale and visible discomfort on face.

DEFICIENT FLUID VOLUME r/t blood in pleural space aeb increased pulse rate of 112 while resting and a BUN level of 30.

Also, he has a minor infection at the wound site (minimal purulent drainage) along with a 100.8 fever but I figured it wasn't important enough to make it to the top 3 ND. What do you think?

[Daytonite, BSN, RN]

Your sequencing is wrong. It should be:

1. IMPAIRED GAS EXCHANGE r/t ventilation-perfusion imbalance aeb blood carbon dioxide level of 55.
   
2. DEFICIENT FLUID VOLUME r/t blood in pleural space aeb increased pulse rate of 112 while resting and a BUN level of 30.
   
3. ACUTE PAIN r/t recent injury aeb patient report of pain being a 7 on a 7-10 pain scale and visible discomfort on face.
   

The tachycardia is also a symptom of the Impaired Gas Exchange. Your evidence of the Deficient Fluid Volume needs to be evidence of hypovolemia (that's what you are hinting at with blood in the pleural space--hemorrhage) such as low blood counts and signs of anemia. A BUN of 30 has to do with lost fluids not hypovolemia. Get your evidence correct.