Ordering Nursing Diagnoses

[samjay009]

So I always have trouble listing my nursing diagnoses by priority. If you could help me out that would be extremely nice. So a little about my patient:

He is a 90 year old man who was admitted with anemia (there was no specification on what kind it was), he also has CKD stage IV, hypertension, Type II DM, and Afib. We need to do care plans on the top three. My top 2 so far are Ineffective Tissue Perfusion and Decreased Cardiac Output.

Here are the others:

fatigue

acute confusion

risk for infection

risk for falls

impaired mobility

activity intolerance

bathing self-care deficit

dressing self-care deficit

imbalanced nutrition: more than body requirements

impaired skin integrity

reflex urinary incontinence.

Which do you think should be number 3 and what order would you put the other ones in?

[NICUismylife, ADN, BSN, RN]

How long has he been in Afib and is he anticoagulated? HUGE risk for CVA. CKD = big risk for kidney failure, electrolyte imbalances, fluid overload. Is he on dialysis? How well controlled are his DM and hypertension? I'm guessing that is what caused the CKD?

This guy has way more going on than the dx that you're listing.

When you are figuring out your dx, always think "what will kill him first?" And then look at what he is at the biggest risk for based on your assessment and his history.

If you are not allowed to do any type of "risk for" or "RC" diagnoses yet, then for priority, you need to reference your assessment. What did you find when you were assessing him that made you feel that Ineffective Tissue Perfusion and Decreased Cardiac Output were a problem for him. Decreased CO usually leads to hyPOtension, and this patient is hypertensive. Some people live with controlled Afib with no symptoms. Is he symptomatic? The anemia combined with Afib and DM would lead me to believe he probably has poor tissue perfusion, but what does your assessment show? How are his pulses? His color, temp, sensation, cap refill in extremities? Has he had amputations performed? What is his SPO2 and hgb? etc.

This is a complex patient. It's always fun connecting the dots. Which disease process caused the others, etc. Enjoy!