Question

Patient History:  History: MI (2020); DM (2000) Complaints: Chest, shortness of breath and weakness; Blood sugar 160 mg/dL at noon

•Based on the history and complaints, which body system (s) is/are being compromised?

3 Nursing Diagnosis

3 Nursing Interventions

3 Patient Intervention

•which diagnosis will best address the patients’ problems?*

Body System Compromised

Nursing Diagnosis

Interventions

Patient Education

Answer 1

•Based on the history and complaints the body system which is compromised are

• Cardiovascular system (MI) ,
• Respiratory system :Shortness of breath
• Endocrine system :Diabetes

Nursing diagnosis

• Impaired cardiac function related to block or decreased blood supply to the myocardium as evidenced by chest ,shortness of breath

Nursing intervention

1. Monitor vital signs ,baseline data to plan for care
2. Administer medications as per order
3. Administration of oxygen

Patient intervention

1. Make dietary changes which are heart friendly
2. Including routine exercise in daily life
3. Taking medication as per order

Nursing diagnosis

• Ineffective breathing pattern /Impaired gas exchange related to decreased oxygen exchange as evidenced by shortness of breath

Nursing intervention

1. Monitor vital signs especially the respiratory rate and the oxygen saturation
2. Administer oxygen to relieve shortness of breath
3. Assess the root cause and provide appropriate care

Patient intervention

1. Encourage to do breathing exercises
2. Encourage patient to be in Fowler position in order to improve lung capacity and oxygenation
3. Encourage to mobilise when comfortable to improve the respiratory functioning

Nursing diagnosis

• Altered blood glucose levels related to decreased insulin production as evidenced by blood glucose level

Nursing intervention

1. Monitor the blood glucose levels
2. Administer antihyerglycemic drugs to reduce high blood glucose
3. Assess for any complications like DKA

Patient intervention

1. Dietary modification
2. Daily walking
3. Medication as per order

•The diagnisus which will best assess the patient are

• ECG :to rule out cardiac changes
• Chest X ray to rule out any problems associated to respiratory system
• ABG to assess gas exchange and acid base balance
• Cardiac biomarkers to rule out MI