Priority nursing diagnosis

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Jimbob came into the ER today. Upon arrival he was anxious, and appeared to be air hungry it was very obvious that he was using accessory muscles in in great distress. He stated that he was in pain that came on. There were no lung sounds on right side about lung sounds on left. Vital signs were, temperature: 37.0°C, pulse 110, respirations 25, blood pressure: 90/60, and oxygen saturation 85% on room air. He was immediately sent for a chest X-ray which confirmed fluid in the pleural space. This required a chest tube drainage system for this patient. The nurse will educate the patient on why the system is being placed and provide education to the patient related to the chest tube drainage system. what are 4 priority nursing diagnosis followed by related and as evidenced by for above patient ?

Reference no: EM133747769

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