Which nursing dx? :(

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I had a pt w/ med dx of hypoxia, HTN. She has Hx of HTN, DM, and TIA. her cap refills were

i was thinking about ineffective peripheral tissue perfussion or impaired gas exchange, but I don't know which one to choose. :crying2: Please help.

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in the care plans i had to do for med/surg, we had to do five nursing dx... but elaborate on only two (priority dx).

i always used maslow's hierarchy and ABCs -- airway, breathing, circulation -- to figure out my priority nursing dx.

what nursing dx book do you have? the ackley/ladwig one was a great help for me.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

nursing diagnoses are always based upon the assessment information that you gathered about the patient. while knowing their medical diagnoses (hypoxia, htn, htn, dm, tia) is helpful in knowing the pathophysiology, or underlying cause of much of the assessment findings, it really is unusable as far as composing nursing diagnostic statements go. we can't use medical diagnoses in nursing diagnostic statements.

the only abnormal assessment (symptoms) information you have listed is:

  • cap refills were
  • dp (dorsalis pedis?) were 1+ (diminished)

oxygen and medications are treatments that were ordered by the doctor to do something for the symptoms that the doctor found during his examination of the patient before he made his determination of the patient's medical diagnoses. what you can do is look at the information provided in the doctor's history and physical in the chart and pick up any signs and symptoms that have been documented there that support the medical diagnoses. we nurses can also address and provide nursing treatment of those symptoms. you should also find the reasons for why the patient is receiving the medications that have been ordered for him. all of this investigation leads to a better understanding of what is going on with the patient as you build a longer list of abnormal assessment (symptoms) information.

that list is important. all nursing diagnoses, like all medical diagnoses, have a list of signs and symptoms. that's how a doctor knows, for instance, that someone has, lets say, conjunctivitis (inflammation of the mucous membrane that lines the eyelid). he assesses and first finds evidence of a discharge from the eye that could or could not be purulent, copious tearing, crusting, and reddened conjunctival tissue with swelling. nanda (north american nursing diagnosis association) has developed listings of signs and symptoms for each nursing diagnosis although they have specifically given them the name of defining characteristics. you need a nursing diagnosis reference of some type to help you in choosing diagnoses for patients. there are a number of ways to acquire this information.

i was thinking about ineffective peripheral tissue perfusion or impaired gas exchange, but i don't know which one to choose.

the choice to use either of these diagnoses depends upon whether or not your patient has the
defining characteristics
, or symptoms, that meet the criteria of the diagnosis. you can see what the defining characteristics for each of these diagnoses is for yourself at each of these webpages:

you will see that your two abnormal symptoms that you posted do not meet the requirements of impaired gas exchange. they do, however, qualify the patient as having
ineffective peripheral tissue perfusion
. you do need to state an etiology for this in your diagnostic statement. this is where the hypoxia and probably some vascular changes due to the diabetes are at the underlying cause. if you look carefully at the definition of this diagnosis you will see that a
"decrease in oxygen resulting in the failure to nourish the tissues at the capillary level"
(page 228,
nanda-i nursing diagnoses: definitions & classification 2007-2008
) is what this diagnosis is about.
impaired gas exchange
is "
excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane"
(pg. 94,
nanda-i nursing diagnoses: definitions & classification 2007-2008
). that is very clearly referring to the lungs and that is not what your assessment information addresses at all! so, to use
impaired gas exchange
would be incorrect.

the related factors (the etiologies, or causes) listed with the diagnosis of
ineffective peripheral tissue perfusion
state this hypoxia of the tissues can happen a number of different ways. with sluggish capillary refills and faint distal pulses my guess would be that there is an interruption of blood flow that is at the heart of the reason for the decreased oxygenation of the peripheral tissues. makes sense to me unless there is something else going on physiologically that you haven't listed. the nursing diagnostic statement would then be:

ineffective peripheral tissue perfusion r/t interrupted blood flow aeb capillary refill

do you see the thinking that goes into determining the diagnosis. it is based upon your assessment and the abnormal symptoms that fall out and then using that information to match defining characteristics that fit with nursing diagnoses.

your next tasks are to develop goals and nursing interventions that are based as well on the two defining characteristics. in case you haven't figured it out by now, the entire care plan is pretty much based upon the abnormal data you find during your assessment and evaluation of the patient. the nursing diagnosis is merely a label you put on a group of this data that seems to fit together. bottom line: for all practical purposes, you, nurse, are going to treat the symptoms (abnormal data) not the nursing diagnosis; the doctor treats the symptoms not the medical diagnosis.

fyi. . .i just wanted to mention the pulse amplitude grading scale since i wasn't sure if you knew it. this is how it goes:

0 - absent

1 - diminished

2 - normal

3 - increased

4 - bounding

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Specializes in Cardiac.

Sweet Jesus yoda, I'd marry you in a heartbeat.

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i have sparks.taylor 7th ed, and a carpentino one

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Specializes in med/surg, telemetry, IV therapy, mgmt.

lisaBawesome. . .did you understand any of what I posted for you, or are you still lost? The care plan books will only help if you have a specific medical disease to care plan for. Or, you understand how to break a medical diagnosis down into its symptoms and extract that information from those books. The problem is that in the real world there are patients who have medical conditions that don't have a specific medical disease, but they have some of the symptoms of a disease. When you are wanting to diagnose that's why you must depend upon what you determine the patient's abnormal data is from the assessment that you did. That is why you need to know the steps of the nursing process. Assessing consists of:

  • collecting data from medical record
  • doing a physical assessment of the patient
  • assessing ADL's
  • looking up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology

The purpose of assessment is to help you discover and look for as many of the symptoms (abnormal assessment data, or defining characteristics) in the patient as possible in order to help in identifying the patient's nursing problems (expressed as nursing diagnoses). Then, you must know, or look up, what the various nursing diagnoses mean to make sure your final choice(s) are correct. That is why I mentioned what the definitions of the two diagnoses were that you mentioned.

If there is something I wrote that you don't understand, please ask. It is better to spend the time to learn this now. Your understanding of it will improve with each care plan and over time. This is also intimately linked with critical thinking skill. This stuff is not always simple and the light bulb doesn't always turn on at first. I have been doing it for many years and you are just beginning. It is commendable that you chose two very related diagnoses. It was a matter of fine-tuning to get to the correct diagnosis.

JustinTJ. . .you crack me up! But I'm not marrying anybody. Been there, done that, learned my lesson! :twocents:

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Specializes in Trauma/Burn ICU, Neuro ICU.

Well dear Daytonite -- I heard you! I save most of your posts in my folders. Many of us benefit from your wonderful wisdom. Thanks.

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Well dear Daytonite -- I heard you! I save most of your posts in my folders. Many of us benefit from your wonderful wisdom. Thanks.

i agree.

daytonite, even if op didn't 'hear' you, so many others, have.

my old intuition is sensing the op is a bit overwhelmed.

leslie

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Airway

Breathing

Circulation

ABCs all the time! If patient isint breathing everything else doesnt matter

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mm k ya i did my care plan already, it was due the nxt day, i figured it out in the end, it just involved pulling an all nighter, bc i had to do med sheets too, thank you though for your advice :)

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Specializes in med/surg, telemetry, IV therapy, mgmt.
mm k ya i did my care plan already, it was due the nxt day, i figured it out in the end, it just involved pulling an all nighter, bc i had to do med sheets too, thank you though for your advice :)

I'm sorry. What did you just write? I don't understand the abbreviations.

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Specializes in SRNA.
I'm sorry. What did you just write? I don't understand the abbreviations.

Yeah, I understand text abbreviations, but I still abhor them. :no: In my opinion, they should not be used on a forum if people expect to get serious and helpful guidance with a question they have. Thankfully Eric E. modified the first post.

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