Nursing Diagnosis help

[91B]

I have a pt that has been in facility since 9/12 for a wound infection sp CABG on 08/16. Discharged 09/07 after treatment for wound infx. Came back on 09/12 for SOB, chest pain, and S/S of infx at wound site. Was also diagnosed with bacteremia and osteomyelitis of the sternum at that time. Due to his financial situation with the VA he can't get home health care, so he is stuck in our facility until at least 10/17. Hx includes CAD, DM(type 2 non insulin dependent), HTN, Anemia (chronic, unspecified), hypercholesterolemia.

So I am looking at 3 nursing dx based on Maslows needs, ranked accordingly.

Infection (Risk for) comes to mind, even though it strikes me odd that there is not a risk, since he most certainly has an infection. But infection is a medical diagnosis, so my understanding is that risk for is what would be used for the nursing dx. But, at this point it is pretty well controlled, so I am not sure that the risk is all that great.

So Ii thought perhaps impaired skin integrity r/t the wound, inadequate nutrition and DM would be a good choice.

His labs are normal, except for WBC, HgB and HcT, all lower values.

With the lowered HgB value and anemia, I was thinking that impaired tissue perfusion due to reduced O2 carrying capacity would be a good choice, but his SPO2 sats were above 90 on room air.

Unsure of the third. I figured that the DM would be important, as it ties to wound healing and immune system, so there is impaired tissue perfusion (renal) but I am not sure if that is really accurate, as his BUN and creatinine labs are normal. There could be something there for inadequate nutrition, both from the DM and the fact that he has been on antibiotics for a month, which is impacting his normal flora in the gut.

Or should I look at the CAD and HTN? I am trying to focus on what I did to treat the patient in the clinical setting - IV antibiotics, wound care, assessment. Impaired gas exchange ties in with tissue perfusion due to the CAD and DM, would that be a good choice?

Or perhaps there is something I am missing entirely.

Any suggestions would be appreciated.

Steve

[hppygr8ful]

If you can get your hands on it pick up a copy of "the Nurses Pocket Guide to Care Plans, Inteventions and rationals." It a paperback and not too expensive.

My first thought from your case scenario would be some kind of Alteration in Comfort Dx.
Followed by a Skin Integrity plan, Also a Nursing DX related to his psychological status would be good.

Hope this helps

Hppy

[91B]

Thanks for the advice. My instructor is very focused on Maslow, and feels that there is always going to be some kind of critical Dx. I ended up using Impaired wound healing r/t DM and nutrition deficit, impaired skin integrity r/t surgical incision, and ineffective health maint r/t knowledge deficit and non compliance.

[Ricu]

Hey Steve,

I know it's probably late but I still came up with a few. He will likely end up with a VAC system for awhile if he doesn't already have one and eventual sternectomy and muscle flap closure so, how about alteration in body image? Alteration in comfort D/T chronic pain?

Keep up the good work,

R