Sorry...its a nursing dx question

[pjcraw]

Hello, I couldn't find recent discussions on nursing diagnoses so I didn't know where to ask this but I need help...

My pt is dx with coronary artery disease (also has hypertension, DM2, hyperlipidemia) but was admitted for atrial flutter. Upon arrival to the hospital HR was 144 and he had an ECG stating he had the flutter. When I actually saw him, his HR was 66 but irregular and was going for a cardioversion--which returned his HR to regular.

Pt states he sometimes has dyspnea on excursion and sometimes, but rarely a dull ache in the location of his heart (nerver dx with angina or anything, but does have nitroglycerine rx'd prn while at the hospital only).

I know that isn't all of the assessment information, but I wanted to get to what I need help with:

Basically, I need to pick a priority diagnosis for this pt. I was thinking "Decreased Cardiac Output" but then didn't know if it should be "RISK OF Decreased Cardiac output" or not, considering now he has had cardioversion, on meds for arrhythmias and an anticoagulant, and HR is stable".

Also, originally I was thinking the priority dx would revolve around the atrial flutter, but then I realized that the whole reason he is getting the flutter is because of the coronary artery disease. Should the priorty dx be based on that then? Or any other suggestions on a priority dx??

Hope I was able to explain myself and gave enough information. Thanks in advance. :)

[Double-Helix, BSN, RN]

For your first diagnosis, I would go ahead and list "Decreased Cardiac Output." For your interventions, list the things that were done during your shift to correct the flutter, and for the evaluation, explain whether or not the interventions were successful.

When deciding on the priority of your diagnoses, first consider the ABC's. Things that affect airway, breathing and circulation take priority. Then consider what problem is likely to harm the patient sooner/most severely. Finally, actual diagnoses always take priority over risk for diagnoses. In this situation, I agree the the decreased cardiac output is definately a priority.

[pjcraw]

thanks! I'm glad I was on the right track.