"Risk for" when it's already present?? Confused...Please HELP me with these NANDAS!!!

[MomBak2Skool]

I have a 36 yo patient in renal failure. He's on dialysis, producing no urine, has bronchitis, hypertension, congestive heart failure, is on 2L/min O2 via nasal cannula, and on remote cardiac monitoring. He presented with shortness of breath and headache but is being kept for observation due to his renal failure, bronchitis, and newly diagnosed congestive heart failure. His WBCs are high, RBCs are low, albumin is low, HGB and HCT are low; BUN and creatinine are WAAAY high and CO2 is high. For one of my nursing diagnoses, I want to put that he has ineffective renal perfusion but I have a few questions:

1. NANDA only has a "Risk for ineffective renal perfusion" diagnosis, not an actual ineffective renal perfusion diagnosis. Can I just take out the "risk for" part or would that not be acceptable? Clearly, I think this man is no longer just "at risk".

2. Would it be accurate to have my "r/t" part be hypertension and renal disease?

3. If I do take out the "risk for" part, what would my "aeb" part be? I was thinking about saying "aeb abnormal lab values and anuria; am I missing anything?

So would this be okay?: Ineffective renal perfusion r/t hypertension and renal disease aeb abnormal lab values and anuria.

Thanks so much in advance for any and all suggestions! (P.S. This is my first concept map/care plan due next week and it's a big part of our grade!)

[Streamline2010]

Is it TISSUE PERFUSION, INEFFECTIVE (SPECIFY TYPE): RENAL, CEREBRAL, CARDIOPULMONARY, GASTROINTESTINAL, PERIPHERAL

http://www.tabers.com/tabersonline/ub/view/Tabers/144866/0/TISSUE_PERFUSION__INEFFECTIVE__SPECIFY_TYPE_:_RENAL__CEREBRAL__CARDIOPULMONARY__GASTROINTESTINAL__PERIPHERAL

This shows some NDs r/t renal function tests. http://www.rnceus.com/renal/renaldx.html

I only made it through 1st year, though, and we were still putzing around with theory at that point.

[MomBak2Skool]

Thanks for the link Streamline! It looks helpful. I came up with this diagnosis...not sure if it's good or not: Ineffective renal tissue perfusion r/t hypertension and renal disease aeb decreased RBCs, decreased Hb/Hct, elevated BUN/Crt, anuria, and fluid overload.

[MomBak2Skool]

I'm still not happy with that diagnosis. I have others that I need to prioritize. Here are the ones I feel are most important, but I don't know which would be my #1, #2, and #3.

Decreased cardiac output r/t altered stroke volume aeb dyspnea, anuria, crackles in the lungs, cough, and restlessness.

Ineffective airway clearance r/t secretions in the bronchi aeb crackles in the lungs and excess sputum.

Fluid volume excess r/t renal failure aeb dyspnea, crackles in the lungs, pulmonary congestion, decreased Hb/Hct, and restlessness.

Risk for electrolyte imbalance r/t renal dysfunction and effects from cardiovascular medications.

Any suggestions are greatly appreciated :)

[MomBak2Skool]

Also, I have no diagnosis for my Genitourinary assessment. True, he is experiencing anuria as I saw him on Wednesday and he hadn't urinated since the Sunday before. But I looked at the impaired urinary elimination diagnosis and he didn't seem to quite fit that. He also doesn't have urinary retention because his kidneys simply aren't making any urine to be retained. The other diagnoses for elimination include incontinence (No), constipation (No...he had a BM the morning I saw him and says he usually has 2 a day), diarrhea (No), and motility problems (No...he had normal bowel sounds). I'd hate to leave that blank but I also don't want to make something up just for the sake of filling in that one area.