Question with my concept map...

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I am doing a concept map for my clincial day and I just have a couple questions about it. Any response would be great.

Here is my information:

20 yr old female

Medical DX: Right Midshaft Femur Fracture

Rod placement.

Abrasions on right abdomen

Contusion on chest

Head Laceration

No past medical HX

on telemetry

Fatty Emboli

Edema to leg

eating poorly

50% weight bearing

High Fall Risk

Staples to left scalp

experiences tachycardia when up

Hypoxia, weaning her off of 02

I'm just having problems with my Nursing DX i'm going to use 4 nursing dx's.

Possible nursing DX's: Acute Pain r/t edema, trauma

Impaired Physical Mobility (but she can walk to the bathroom now and out in the hallway with therapy)

Risk for impaired Skin Integrity r/f shearing forces when moved

Risk for Injury r/f unsteadiness when ambulating, high risk for falls

Anxiety/Fear r/t change in health status, trauma, tachycardia

Risk for Peripheral Neurovascular dysfunction r/f tx of the fracture

What do you think? I'm just having trouble narrowing it down...

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Does she have a fat embolism? If so, where?

Prioritization of nursing Dx's is important. Look for things that have the potential to end your patient's life first.

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How's her breathing? You mentioned contusions to her chest and being on 02. I'm thinking ineffective breathing pattern, or impaired gas exchange r/t ineffective chest wall expansion. Its usually better to use more actual diagnoses vs risk for.

It sounds like she may have orthostatic hypotension too. Were you able to take her bp laying sitting and standing? This would also put her at risk for falls.

How's her mental status? You also mentioned lacerations to her head. How was your neuro assessment?

Of the diagoses you've listed I would use Impaired mobility & acute pain.

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