What would be the main priority in this scenario

Nurses General Nursing

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Fatigue related to inadequate tissue oxygenation secondary to anemia.

Activity intolerance related to comprised oxygen transport system secondary to cardiomyopathy and MI.

Would fatigue be first since you would be able to alleviate that if you're able to treat the anemia. And if you treat the anemia there would be more oxygen in the blood which could help the activity intolerance, right? I'm so confused, please help.

This is a patient who is also on 2L of O2.

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Specializes in Emergency; med-surg; mat-child.

Homework?

What are your AEBs? It's hard to call the priority here without them, I think.

Me, I I don't think I'd tx the anemia first unless it was a critical level (what's the hgb?); I'd be more concerned about the cardiac issues. When was the MI? Is the pt on a cardiac floor right now, or is this something from the H&P that was years ago? Either way, if they're having sequelae from the MI, isn't that going to be your primary concern?

If the hgb is low enough to call for a transfusion, then that would probably be the dx to work on first, but again, without more info I think you could argue in favor of either as the primary.

I see fatigue as a problem but not as big a problem as activity intolerance. That implies inability to do things, whereas fatigue implies being able to do things but getting tired after a while. I don't have my ND book close to hand, though, so I don't know what it says.

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Specializes in ER, Trauma.

With the information you gave, my first thought would be to increase the O2 flow if not contra-indicated. Quick and easy. The other stuff is going to time to alter. Your logic is sound and shows your understanding of whats going on, but how are you going to treat anemia? Transfusion and find/fix the cause of the anemia. Takes way to long to be effective. But that's an ER nurses view, the good old ABC's. Maybe others will have better ideas, or you can give more details.

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Specializes in Ambulatory Surgery, PACU,SICU.

Increase the tissue oxygenation by increasing the O2. What is the hgb?

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Specializes in SICU/CVICU.

Before answering the question one would need to know the oxygen saturation, the hemoglobin and the cardiac output. When you have that inforation you can run the numbers and see which part is preventing adequate oxygen delivery.

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cardiac first.

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The hemoglobin is 9.4, O2 saturation is 95% on 2 L, and I don't know the cardiac output but the ejection fraction is 20%.

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Specializes in Hospice / Psych / RNAC.

A 20% injection factor ... would you consider it low?

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Yes, I would consider 20% very low. So I think activity intolerance should be the first priority?

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I would go with activity intolerance before the fatigue as well. For all the reasons above. But ahead of that, I'd want to look at something more along the lines of the ABCs.

It seems a million years ago, but I always got my best grades on care plans where I mixed a more acute thing with a more long term thing. (Shows you're both seeing the big picture and seeing the immediate problems.)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I. Physiological Needs

A. Oxygen

1. Respiration

2. Circulation

B. Nutrition

1. Food

2. Fluid and Electrolyte Balance

C. Elimination

1. Urine

2. Stool

3. Skin

D. Comfort (rest, sleep, hygiene, pain, etc)

E. Activity

1. Motor Function (bone/muscle)

G. Sexuality

II. Safety and Security

A. Peace of Mind

B. Protection

C. Lack of Danger

III. Love/ Feeling of Belonging

A. Interpersonal Relationships

1. Social (family, peers, etc)

2. Emotional (nurses, etc)

3. Giving and Receiving of Love or Friendship

IV. Self-Esteem

A. Self-Reliance

1. Respect

2. Esteem

3. Confidence

4.Trust

B. Reputation

1. Achievement

2. Leadership

3. Autonomy

4. Independence

C. Leisure-Diversion

V. Self-Actualization

A. Learning

B. Realization of One's Potential

C. Ability to Adapt to Stress

It is thought that if the patient is in extreme pain and otherwise stable, you should address the pain as your first concern. Otherwise, you are pretty safe in going by this sheet and figuring out what your priorities are. In this situation, you have impaired tissue integrity and ineffective perfusion. Circulation is in the first block of needs, so I think you should prioritize ineffective perfusion first and impaired tissue integrity second.

https://allnurses.com/general-nursing-student/help-care-plans-286986.html

http://www.pterrywave.com/nursing/care%20plans/Nursing%20Care%20Plans%20TOC.aspx

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Specializes in SICU/CVICU.

If the patient's hbg is 9.4, the SaO2 is 92 and the CO is about 3 (a total guess based on the EF), then the patient's oxygen delivery is about 347 ml of oxygen per minute. Since normal is somewhere between 700 and 1400, clearly the patient's delivery is way too low.

If you transfuse the patient to a hgb of 11 and nothing else changes the delivery would be increased to 406 ml of oxygen per minute

If you decide to increase the patient's saturation to 98% and change nothing else the delivery would be increased to 370 ml of oxygen per minute

If you decide to increase the patient's cardiac output to 4 liters and change nothing else the delivery would be increased to 463 ml of oxygen per minute.

So none of these things will increase oxygen delivery to an appropriate level, however if you change all of them, then the oxygen delivery would be increased to 577 ml of oxygen per minute. Probably still not quite enough but significantly more than you started with.

Hope this helps

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