Proper diagnosis?

Published

I've been going back and forth all night on which is the proper nursing diagnosis for my patient. His primary medical diagnosis was "Aspiration" (difficulty swallowing and food goes into lungs...we had to put him on peg tubing)

Well I'm trying to figure out if I should focus my ND more on the "Ineffective airway clearence" or "Impaired swallowing"? Or are both of theses completely wrong?

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

It all depends on what your assessment data showed. Both diagnoses have specific criteria. Does this pateient have any of the criteria of them? Did you read the definition of each diagnosis?

Up Vote Up Vote ×

We follow ABC's in prioritizing NDs, airway comes first.

Up Vote Up Vote ×

I read each diagnosis but I still seemed to have trouble. Like with the "Impaired swallowing" I wasnt sure what the r/t part could be because my teacher told me for that you just plug in the pathogenisis (of what the pmd is). But does this even make sense?

"Impaired swallowing r/t acute, chemical lung injury resulting from the inhalation of gastric contents aeb coughing and decreased gag reflex."

I would think that that etiology would be more related to not being able to breathe not from not being able to swallow...

He also had a CVA 5 years ago. Am I allowed to use CVA as my etiology for impaired swallowing?

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

the pathogenesis is needed to determine the related factor (cause) of the problem. however, it is the actual symptoms that the patient has that determine what the actual problem is because the symptoms are the evidence proving the existence of the problem.

if you have a dead body with a knife protruding from the chest you have a murder--not an embezzlement. the evidence is the dead body with the knife protruding from the chest. the related factor (pathogenesis, cause) of this murder might be that the victim didn't pay off the loan shark who he owed $100,000 to, so the loan shark killed him. that's a reason for the murder. murder r/t money owed to loan shark aeb dead body with knife through heart.

what you are looking for is reasons for impaired swallowing or ineffective airway clearance. but do either or both of these problems exist? determine that first because you don't seem sure of that. do you have mucus, food or both plugging up the pharynx? then, why?

what are the patient's symptoms? the symptoms are listed with each diagnosis in the taxonomy (i listed links to the taxonomy for these two diagnoses below). so, are ideas for related problems (reasons for the problems to have occurred)

impaired swallowing (has to do with difficulty moving food from the mouth through the pharynx and esophagus and to the stomach) impaired swallowing:

  • oral phase impairment: lack of tongue action to form bolus; weak suck resulting in inefficient nippling; incomplete lip closure; pushing of food out of mouth; slow bolus formation; falling of food from mouth; premature entry of bolus; nasal reflux; inability to clear oral cavity; long meals with little consumption; coughing, choking, or gagging before a swallow; abnormality in oral phase of swallow study; piecemeal deglutition; lack of chewing; pooling in lateral sulci; sialorrhea or drooling
  • pharyngeal phase impairment: altered head position; inadequate laryngeal elevation; food refusal; unexplained fever; delayed swallow; recurrent pulmonary infections; gurgly voice quality; nasal reflux; choking, coughing, or gagging; multiple swallows; abnormality in pharyngeal phase by swallowing study
  • esophageal phase impairment: heartburn or epigastric pain; acidic-smelling breath; unexplained irritability surrounding mealtime; vomitus on pillow; repetitive swallowing or ruminating; regurgitation of gastric contents or wet belches; bruxism; nighttime coughing or awakening; observed evidence of difficulty in swallowing (e.g., stasis of food in oral cavity, coughing, or choking); hyperextension of head, arching during or after meals; abnormality in esophageal phase by swallow study; odynophagia; food refusal or volume limiting; complaints of "something stuck"; hematemesis; vomiting

ineffective airway clearance (has to do with removing mucus from the pharnyx so the person can breathe) ineffective airway clearance:

  • dyspnea; diminished breath sounds; orthopnea; adventitious breath sounds (rales, crackles, rhonchi, wheezes); cough, ineffective or absent; sputum production; cyanosis; difficulty vocalizing; wide-eyed; changes in respiratory rate and rhythm; restlessness

does that help?

Up Vote Up Vote ×
Specializes in Geriatrics, Triage, Cardiac ICU.

I would, personally, be more concerned about "Impaired gas exhange" because of the aspiration in agreeance with znov11 that airway always comes first. I would them move on to "Risk for aspiration or Impaired swallowing" related to dysphagia caused by (CVA patho). Perhaps you could use "Ineffective cerebral tissue perfusion" to diagnose the CVA and reasons for dysphasia and aspiration as CVA would be considered a positive, chronic diagnosis.

Up Vote Up Vote ×
+ Join the Discussion