After several doses of chemotherapy, a client complains of fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia. Which NANDA nursing diagnosis would the nurse list as the first priority?
1. Imbalanced Nutrition, Less than Body Requirements
2. Activity Intolerance
3. Powerlessness
4. Ineffective Coping
2. Activity Intolerance
Rationale:
The symptoms (fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia) are caused by aplastic anemia from bone marrow suppression, which is a side effect of the chemotherapy drugs. Decreased red blood cells cause less oxygen to be delivered to body tissues, resulting in tissue hypoxia. Tachycardia is a compensation mechanism to speed up the delivery of oxygen that is available in the fewer number of cells that are present. Tissue hypoxia will result in muscle fatigue, and the symptoms that are related to aplastic anemia will decrease endurance and ability to perform activities. Thus, this NANDA diagnosis should be the first priority. Nutrition or iron deficiency is not the cause of the symptoms, which are related to tissue hypoxia. Powerlessness is the lack of control over current situations, but this is not the client's current problem. Her needs/symptoms are physical, and according to Maslow's theory must be met prior to emotional needs. Although the client might be having coping issues, the physical symptoms are her greatest complaints; therefore, coping is not the top priority in planning her care. Again, physiological needs must be met prior to self-actualization needs.
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