[MizDnurse2b]

I am in some major need of assistance. I am a first semester LPN student and am having difficulties in prioritizing my nursing dx in order to get my care plan going. I don't have any trouble coming up with the nursing dx ( I can usually find more than enough). My problem is narrowing it down to the really important ones and then putting them in order of importance. To me they are ALL important. I have tried the "ABC" method ( airway,breathing etc.) Any advice from seasoned nurses or students would be greatly appreciated!! Thanks so much!

[dacryocystitis]

I always thought of the ABC's first and Maslow's Hierarchy of Human Needs. Physiological needs always come first: breathing, food, water, sleep, excretion. Think of things needed for survival. Everything else comes after that....safety, love/belonging, esteem, self-actualization.

As you learn more and become more experienced, prioritizing needs will become much easier.

[TriageRN_34]

There is a ton of posts about this in the student nursing forums (stickies) from nurses that have volunteered to help with RN Dx. I have even gone there to give my tricks of the trade on them by request!

Try looking there too .

Priority to me is life threatening to non dependant on condition of the patient. For example..they may have a probelm with asthma and I put inaffective airway or altered gas exchange or what not as first since that is going to be the first probelm in this condition...but what about the other systems that effects? Well..then I have to prioritize according to actual risk vs potential risk (where actual comes in first). What if they are asthmatic but that isn't why they are there? Well..why are they there? Lets go with that first . They are falling alot and getting confused. Okay fall risk RN Dx first...and then I will go into the possible reasons for it like ineffective gas exchange, altered electrolytes, inaffective airway clearance, etc. dependant on the patients most urgent need for treatment!

Takes some getting use to...but good luck!~

[cardiacRN2006]

Also, what my Clinical Instructors liked to see was a RNDx related to the specific reason for admission.

But, as a general rule, ABCs and Maslows are your best friends.

[FutureNurse35]

I am a new RN student and so far all my nurses diagnosis have been excellent. My first care plan, daynonite was really helpful in guiding to the right track.
This is what I do: I check all the lab results, assess the patient, check the patient charts, check meds, medical history, medical diagnosis, from there, I cluster the data and come up with a diagnosis. For example, my last patient was diagnosis was impaired mobility r/t altered nutrition, my pt had not eaten for 2 days, was anorexia, lost 20lbs in 2 months, albunim was below the level, which tells me he was malnourished, he was fragile, he stated he was weak and needed assistance to walk. My plan was for my pt to eat at least 40% of the food on his tray with assistance, walk 20ft etc. He achieved the goals.

[adria37]

Girls here is your care plan generator


http://www1.us.elsevierhealth.com/Ev...uctor/A-B.html


:studyowl:

[MizDnurse2b]

That website is awesome! Thanks for all the info everyone! It is greatly appreciated !!

[Daytonite]

Hi, MizDnurse2b!

Most nursing programs direct their students on how to prioritize their nursing diagnoses. Maslow's Hierachy of Needs or Gordon's 11 Functional Health Patterns are two common systems of organizing nursing diagnoses by priority. NANDA actually started out using Gordon's Functional Health Patterns years ago when it was grouping the diagnoses. They've tweaked it a bit, but in their publication, Nursing Diagnoses: Definitions & Classification 2005-2006 published by NANDA International, you can definitely see the similarity to Gordon's work. When I am responding to student questions on prioritizing nursing diagnoses, I go by Maslow. Maslow really lists the priorities for you so there isn't much thinking on your part. It also takes ABCs into account. Here is a website where you can read about the Hierarchy. http://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs If you happen to have a copy of Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig, the Maslow pyramid is printed out on page 1325. The bottom of the tier of the pyramid is physiological needs and that is what takes precedence. Within physiological needs the prioritization from most important to least important is as follows:

1. oxygen (this takes into account your ABCs, tissue perfusion, etc. - remember the brain must get it's oxygen first and foremost, then the heart, then the remaining tissues of the body)
2. food (ultimately an organism can't live without food, water, and electrolytes)
3. elimination (or, a way to get rid of waste products)
4. temperature control
5. sex
6. movement (gross movement takes priority over finite movement)
7. rest
8. comfort (this is where things like pain and some of the ADLs rank)

The Ackley/Ladwig book goes on in the next few pages to list the nursing diagnoses that fit under each tier of Maslow's pyramid.

Any diagnoses that are anticipatory, such as those that begin with the words "Risk for" always are listed at the very end of your diagnostic lists because they are not actual problems, but problems you are trying to prevent. Within them, you also prioritize by the same logic you used for the actual problems that are listed before them.

There are three "sticky" threads on the student nursing forums where a lot of care planning and nursing process information from past postings has been accumulated. Some of it is well-worth looking at. I recently posted websites where you can view sample case studies that have been done by students.

• http://allnurses.com/forums/f205/health-assessment-resources-techniques-forms-145091.html - Health Assessment Resources, Techniques, and Forms (in Nursing Student Assistance Forum)
• http://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html - Desperately need help with careplans (in Nursing Student Assistance Forum)
• http://allnurses.com/forums/f50/careplans-help-please-r-t-aeb-121128-7.html - CAREPLANS HELP PLEASE! (with the R\T and AEB) (in General Nursing Student Discussion Forum)

Just yesterday we had a thread going on the difference between a goal and an outcome. You can read it here: http://allnurses.com/forums/f50/help...me-187170.html

I invite you to at least peruse the threads on these two student forums on a regular basis for information and help with care plans. While I understand that you posted in this forum because you are thinking of the experience factor of licensed nurses, I fashion my answers for students to conform with what they are being required to provide on care plans by their instructors, not for what goes on in actual practice. Care plans being done for school have the much broader purpose of helping you to learn to think critically as well as to learn about diseases, their treatment and the nursing interventions that are possible.

I check these two forums almost daily for student questions about care planning and nursing diagnosis.

• http://allnurses.com/forums/f205/ - Nursing Student Assistance Forums
• http://allnurses.com/forums/f50/ - the General Nursing Student Discussion forum

The link that was given to you above by adria37 is from the Ackley/Ladwig care plan constructor. I often link students into some of the nursing diagnosis pages from the site. Let me advise you, however, that the site does not help you with prioritizing your diagnoses. The nursing diagnoses do not have the complete listings of nursing interventions that are printed in the book. The website also does not contain a complete listing of the 172 NANDA nursing diagnoses. There have been numerous times that I have gone to their index to search for a specific nursing diagnosis only to find that it has not been included in the website. To have a complete list you really should invest the money in their book (I've listed it above).

If you are having problems getting your care plan going, either post a thread to one of the above forums or PM me. And, by the way, in the nursing process, your nursing diagnoses should always be chosen based on the assessment data that you have collected about the patient. That is what drives any care plan. Ask and I will help you.