problem facing when doing nursing diagnosis please help!

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when i am doing my assignment, i found that it is hard to desire what diagnosis to be used and their priority, i do not know what rules to use in order to find the best diagnosis and prority in the case, ( severity? the cause? )

i think of impair gas exchange, acute pain and hypertension

as the defination of impair gas exchange is the deficit( or excess , but not in this case) in oxygenation (or carbon dioxide elimination ) at the alveolar-capillary membrane. what i think is the artery is narrowed with the fatty tissue or the clot this make the oxygen cannot deliver to the cell effectively and the symptom seems siutable for this case such as hypoxia(spo2 93%), dyspnea (rr28) tachycardia (Hr110).

acute pain is obvious since that the patient complain of chest pain with pain score 8/10 radiation to the shoulder.

hypertension due to urti

i think oxygen supply is not enough for the patient and it is the cause of mi as well therefore, we should provide oxygen for him asap. am i wrong or there is better solution?

here is my situation,

a man 55 years old, admited to hospital due to severe chest pain and diagnosed with myocardial infraction with history of hypertension, he is conscious and alert on arrival to hospital.

BP 105/79mmHg, Hr 110/min, Temp: 38.2, SpO2 93% (room air) RR 28beats/min Body weight 80kg, height 160cm, pain score 8/10 radiation to shoulder, profuse sweating and cool in extremities.

complain of runny nose, coughs and fever 2 days before and diagnosed with urti, he was coughing and sneezing frequently and refuse to wear surgical mask, he clam he didnt know the importance of wearing surgical mask and didnt know the proper way in wearing the mask, he showed anxious about condition

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Specializes in NICU, ICU, PICU, Academia.

Priority is best determined by asking yourself "What will kill my patient the fastest?" That is your priority.

Also, is your key broken?

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So I'm not in nursing school yet, but my limited understanding of nursing diagnosis is that you need to think about what you can do as a NURSE and what is happening with the patient - not just the symptoms. Don't try to figure out what caused the MI that's not the nurses job.

I'm just spitballing here - because again I DO NOT HAVE ANY TRAINING - so please don't use my post as an answer to your homework - you'll probably fail.

Also from general googling ... a RR = 28 (it is fast for a normal healthy person) isn't unusual for someone with an URTI nor is an spO2 = 93 (it is low for a normal healthy person though)

His BP isn't currently elevated, his temp is slightly elevated

His HR IS elevated - but is that because of his illness or because of his anxiety - which could be because of his limited knowlegde on why he's got to wear the mask

If he currently got 8/10 pain, sweating w/ cool extremities and shoulder radiating pain, then maybe it's anxiety but maybe it's that MI he was admitted with coming back to bite him a second time.

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ETA - if I'm WRONG I'd love feedback :D nicely if possible ;)

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Specializes in Geriatrics.

I think that addressing his pain is a good one :)

If it is another MI then keep "MONA" in mind... what would decrease that chest pain and why?

If it is anxiety.. you can treat both anxiety and pain at the same time.

Just my thought, good luck

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