AIIMS Raipur - 2017 (…: Which of the following nursing diagnoses is a priority for a patient diagnosed with pneumonia?

AIIMS Raipur - 2017 (Shift-3)

Medical & Surgical Nursing

Medium

Appeared in: AIIMS Raipur - 2017 (Shift-3)

Explanation

Pneumonia is an infection that causes inflammation and fluid to fill the alveoli in the lungs.
This fluid accumulation directly obstructs the transfer of oxygen into the bloodstream and the removal of carbon dioxide, a condition defined as impaired gas exchange.
Based on the ABC (Airway, Breathing, Circulation) prioritization framework, addressing 'Breathing' is a top priority to prevent life-threatening hypoxemia.
Assessment findings for Impaired Gas Exchange include dyspnea, restlessness, confusion, and abnormal blood gas values.

Option A: While a patient with pneumonia is at risk for dehydration due to fever and increased respiratory effort, this addresses 'Circulation' in the ABCs, which is a lower priority than an immediate 'Breathing' problem.
Option C: Ineffective coping is a psychosocial diagnosis. According to Maslow's hierarchy, physiological needs like breathing must be met before addressing psychological or emotional needs.
Option D: The patient already has an active infection (pneumonia). The priority is to manage the life-threatening complications of the current infection, such as impaired gas exchange, rather than the potential for a future infection.

Visual 1: Diagram - A side-by-side comparison of a healthy alveolus and a fluid-filled alveolus in pneumonia. This visually explains why gas exchange is impaired.
Visual 2: Flowchart - A chart illustrating the ABC (Airway, Breathing, Circulation) framework for prioritization in nursing, showing 'Breathing' as a top-level priority.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prioritization of nursing diagnoses for a patient with pneumonia to guide bedside assessment, documentation, and the next nursing action.
Nurses must prioritize care based on the most immediate threat to a patient's life. For respiratory conditions like pneumonia, this is almost always oxygenation.
Key nursing interventions for impaired gas exchange include monitoring oxygen saturation (SpO2), administering supplemental oxygen as prescribed, positioning the patient in a high-Fowler's position to maximize lung expansion, and encouraging deep breathing and coughing.
What if? If the patient with pneumonia also had a blocked airway due to excessive, thick secretions, the priority diagnosis would shift to 'Ineffective Airway Clearance' because a clear airway is the 'A' in ABCs and must be established before 'B' (Breathing/Gas Exchange) can be effective.

How to Approach the Question

First, identify that this is a prioritization question, asking for the 'priority' nursing diagnosis.
Next, analyze the patient's condition: pneumonia. This is a primary respiratory disease affecting the lungs.
Apply a standard prioritization framework, such as the ABCs (Airway, Breathing, Circulation) or Maslow's Hierarchy of Needs (physiological needs first).
Evaluate each option based on the chosen framework. 'Impaired gas exchange' directly relates to 'Breathing' and is a critical physiological need.
Compare the options. A problem with breathing is a more immediate threat to life than potential fluid loss, coping issues, or the risk of a new infection.
Select the diagnosis that addresses the most immediate life-threatening consequence of the patient's condition.

Concept Tested & Keywords

Concept Tested: Prioritization of nursing diagnoses for a patient with pneumonia.
Stem keywords: nursing diagnoses, priority, pneumonia
Lead-in keywords: priority
Clinical cues: patient diagnosed with pneumonia
Negative lead-in flag: false

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Brunner and Suddarth's Textbook of Medical-Surgical Nursing p. 1789-1800