: impaired gas exchange related to low rbc count as evidenced by pallor on the face and fingers, and dyspnea.
this diagnosis is used when the patient has a respiratory problem and something is medically wrong with the lungs. that doesn't sound like what is happening here. the related factor (low rbc count) must be what is causing the nursing problem which you are diagnosing as impaired gas exchange which is defined as excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane (pg. 112, nanda international nursing diagnoses: definitions and classifications 2009-2011). a low rbc count is not how an excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane occurs. you have to look at the baby's medical diagnosis for the reason why the alveoli of their lungs are filled with mucus or other debris which interfere with the exchanges of the oxygen and the carbon dioxide gasses. if the problem of inadequate oxygenation is because of a medical diagnosis of anemia but the lung alveoli are clear to auscultation then you have diagnosed this nursing problem incorrectly.
although the baby's rbc count is low are these hemoglobin (68 gm/l) and hematocrit (0.23%) levels high? [american labs measure hgb as grams/dl and hct in whole numbers percentages.] if so, then deficient fluid volume is the problem and not impaired gas exchange. other symptoms of anemia are fatigue, weakness, headache, sore tongue, drowsiness, malaise, and gi disturbances. some of these may be the origin of the baby's irritability since a baby cannot speak and tell us what problems they are having. the baby's symptoms need to be broken down, listed out and other nursing problems considered.
regarding your nursing interventions. . .interventions must address the objective and subjective cues (signs and symptoms, or evidence) that support the existence of the nursing problem which you give as pallor on the face and fingers, and dyspnea. several of your interventions or their rationales made no sense:
- monitor vital signs, note for changes in cardiac rhythm (rationale: hypoxia is associated with signs of increased breathing effort.) ???
- this is an intervention that sounds more like it belongs with a nursing diagnosis of activity intolerance
- administer meds as indicated:- ferlin i ml bid-folic acid 5 mg i tab bid-fortum 270 mg iv q2h nst (rationale: drug therapy helps to increase haemoglobin levels and promote maximum potential of wellness) - i could not tell from this care plan if hemoglobin levels were elevated or decreased. it is never brought up.
- why the iron and folic acid? is there a dietary deficiency of iron and folic acid in this baby's diet? is that the real nursing problem here: imbalanced nutrition: less than body requirements related to lack of ingestion of iron and folic acid as evidenced by . . .
- and these two interventions are opposite to each other and were confusing to me:
- recommend quiet atmosphere and bed rest if indicated (rationale: this enhances rest to lower body’s oxygen requirements and reduces strain on the heart and lungs.)
- recommend mother to stimulate the baby to cry once in a while (rationale: enhances lung expansion to maximize oxygenation for cellular uptake.)
regarding goals. . .our goals must be nursing oriented. your goals are:
- display laboratory values within acceptable range
- what are the acceptable ranges? i was using mosby's diagnostic and laboratory test reference to check the hemoglobin and hematocrit levels that you had listed on your care plan. never assume that the people reading your care plan know what you are talking about. i'm in america. where are you? i figured out pretty quickly that you probably weren't in america.
- manifest glow on the face and return of color on the fingers
- what is a "glow"? how do we scientifically describe "color on the fingers"?
for your evaluation of the goals you wrote. . .goals partially met as evidenced by:
- increase hemoglobin level after blood transfusion
- return of pinkish color on both hands and face.
the hemoglobin level elevated as a result of a medical intervention not
because of any nursing intervention that you ordered. you need to evaluate whether or not the patient was able to "display laboratory values within acceptable range
" based upon the nursing interventions that you ordered in this nursing care plan. in other words, did you plan work? that is what you are evaluating. i looked pretty closely at your nursing interventions. there were no independent nursing intervention that even talked about how
to go about elevating the rbc count. it was all because of the doctor's orders. if giving a blood transfusion, iron and folic acid did it, what was the nursing part in all of this?
again, i have to point out that impaired gas exchange
is about the excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane
and addresses the respiratory system. i do not believe you have diagnosed this patient's problem correctly. this really sounds more like a problem of deficient fluid volume especially
if the patient had to receive a blood transfusion.