Question

Recognizing Subjective and Objective Data and Nursing Diagnoses A. The risk for Aspiration (Inhaling fluids) B. Fear, E,.activity Intolerance F. Ineffective Breathing Pattern C Anxiety D Risk for Impaired Skin Integrity G. Ineffective Airway Clearance H. Impaired Skin Integrity.

1. Mrs. Taft is 92 years old. She has just had a hip replacement done yesterday. She is very thin, her skin is dry, but she has no skin break down noted. She says she is afraid of moving because of pain in her hip.

      Of the above data, which is Objective?

      Of the above data, which is Subjective?

      Which nursing diagnosis would you choose for her? _____

Answer 1

A. Risk for aspiration:

Subjective data: patient says " I am not able to swallow properly"

Objective data: patient's head position is improper and sometimes gag on his own saliva.

Nursing diagnosis: risk for aspiration related to inhalation of fluids as evidenced by gaging reflexes.

B. Fear:

Subjective data: patient says" I am scared, what has happened to me?"

Objective data: on observation, patient shows signs of anxiety and becomes pale and cold when meeting with the physician.

Nursing diagnosis: dear related to disease condition as evidenced by disturbed behaviour.

C. Anxiety:

Subjective data: patient says " I am very nervous, and because of that I am not able to sleep properly"

Objective data: on observation, the patient acts very anxious and frequently asks several questions.

Nursing diagnosis: anxiety related to hospitalisation and disease condition as evidenced by asking of frequent questions and panicking at times.

Answer:

1. Of the above data, the objective data is: on observation she is thin, skin dry, but no skin break

2. Subjective data: patient says she is afraid of moving because of pain in her hip

Nursing diagnosis: risk for impaired skin integrity related to activity intolerance as evidenced by dry skin over the area.