trying to choose the best r/t factor for my nursing dx

[kimberlyr41280]

I have a care plan to do and finish the rest of the Nursing dx:NURSING DIAGNOSIS: INEFFECTIVE AIRWAY CLEARANCE R/T_________________________________________________________________________________________________ m/b____on a pt who:A 68 year old man with a significant history of COPD underwent a tracheostomy 2 weeks ago after spending several weeks on a ventilator in the ICU. The client failed several attempts at being weaned off the vent and a decision was made to insert a permanent tracheostomy. The client suffered a large stroke during his time in the ICU and has permanent disability from this. Using the following assessment data, create the care plan as outlined in the clinical guidelines.

We came up with

Ineffective airway clearance r/t increased secretions secondary to artificial airway m/b RR 20-28, mild dyspnea, use of upper accessory muscles, rhonchi throughout lung fields, occasional wheezes, and thick white/tan secretions.

I was wondering if it would be better or even acceptable to use COPD as the r/t. I know we can't use medical dx in a nursing dx, but I am looking in my tenth edition Nursing Diagnosis Handbook and COPD is coming up as an approved NANDA r/t.

So, my question is two parts: Can I do COPD and would it be better to concentrate the dx on the COPD and secretions or the secretions and the trach(artificial airway).

Oh, and can we have two etiologies in the same nursing dx. Thanks so much for any tips.

[Double-Helix, BSN, RN]

While the underlying COPD is playing a part in exacerbating the problem, what you have written is most correct. When trying to prioritize, ask yourself a couple of questions: 1. When did the problem start? 2. What is the most likely cause? and 3. If I fix one problem, will another problem improve/resolve?

Were increased secretions the reason the patient couldn't be extubated, or was it the COPD? Did the ineffective airway clearance begin after the tracheostomy? If you fix (or optimize) the COPD, will increased secretions still be a problem? Yes, because the patient still has a new tracheostomy and many patients, even without COPD, require frequent suctioning and assistance clearing secretions after a new trach. If you took away the secretions related to the trach, would the patient still have ineffective airway clearance? Maybe, because of the inherent nature of COPD, but it wouldn't likely be the priority problem.