What Dx to use for asthma exacerbation?

[newbie08]

We're supposed to pick 3 and we are not supposed to use 'risk for' unless the CI approves it. So I'm thinking:

1. Ineffective Breathing Patterns

2. Ineffective Airway Clearance

3. Anxiety

I really wanted to use Risk for Impaired Respiratory Function so I may run that one by my CI tomorrow...

We don't have to do the 'Dx r/t ____' yet. We're just keeping it simple. Would you use these Dx?? Any other suggestions?? Thanks!

[Meriwhen, ASN, BSN, MSN, RN]

impaired gas exchange

daytonite wrote a good post explaining why in this thread:

https://allnurses.com/forums/f50/asthma-impaired-gas-exchange-302401.html

[newbie08]

Thanks!! That was very helpful!!

[Daytonite, BSN, RN]

an exacerbation of asthma is a very serious and real problem for someone. you need to read about asthma and what an asthma attack entails. it is a very serious situation. http://www.merck.com/mmpe/sec05/ch048/ch048a.html (talks about treatment of exacerbation towards the lower 2/3 of the page) but early on tells you about the symptoms:

"patients with more severe disease and those with exacerbations experience dyspnea, chest tightness, audible wheezing, and coughing. . . signs include wheezing, pulsus paradoxus (ie, a fall of systolic bp > 10 mm hg during inspiration), tachypnea, tachycardia, and visible efforts to breathe (use of neck and suprasternal [accessory] muscles, upright posture, pursed lips, inability to speak). the expiratory phase of respiration is prolonged, with an inspiratory:expiratory ratio of at least 1:3. wheezes can be present through both phases or just on expiration, but patients with severe bronchoconstriction may have no audible wheezing because of markedly limited airflow. patients with a severe exacerbation and impending respiratory failure typically have some combination of altered consciousness, cyanosis, pulsus paradoxus > 15 mm hg, o2 saturation (o2sat) 45 mm hg, or hyperinflation."

the very fact that there are symptoms means that the patient has problems. symptoms must be translated into diagnoses. we are more used to seeing symptoms translated into medical diagnoses, however, they are also configured into nursing diagnoses as well. you already believe ineffective breathing pattern (ineffective breathing pattern), ineffective airway clearance (ineffective airway clearance) and anxiety (anxiety) are present. you need to look up the defining characteristics of these diagnoses in a nursing diagnosis reference to see what their nanda definitions and defining characteristics (signs and symptoms) are. those blue weblinks next to each one are nursing diagnosis pages that have that information that you can look at.

"risk for" diagnoses are not real problems at all. they are anticipated problems that do not even exist. to say a person with exacerbated asthma has a risk for impaired respiratory function is to completely ignore that the person is already having a problem breathing. what are you going to do about this person's symptoms of bronchoconstriction and inflammation of their airway (the 4 cardinal signs of inflammation include redness, heat, swelling and pain) while you are fooling around preventing impaired respiratory function, whatever you define that to be? it is not even an official nanda diagnosis. you said you wanted to keep things simple. then, first things first. take care of the problems the patient already has and get this patient some help for the problems they do have. if you have evidence of dyspnea, cyanosis or abnormal abgs you need to be using impaired gas exchange as a priority nursing diagnosis.

[Stephcsulb]

@Daytonite Thank you sooo much, your summary is very helpful to me with my current patient care plan :)