Prioritization of psych dx

[MB37]

Hey all,

I'm writing my first psych care plan, and I have a quick question. I know that typically we prioritize actual dx higher than risk for dx, and I've always gotten great grades on my M/S care plans. My pt was admitted to the inpatient unit for suicidal ideation/intent and also suffers from chronic pain. It seems to me that in this case, risk for self-directed violence is a higher priority nursing dx than chronic pain. Is that true? The instructor that has been there with us has no psych background, since the one we're supposed to have who is grading our assignments had to miss a few weeks r/t illness.

We're really not supposed to talk about our patients even generally for psych, so I don't really want to list all of her S/S on a public forum like I have before when asking for care plan advice. If the patient was admitted specifically for threats to kill herself, does that take priority over chronic pain? Thanks so much, and sorry I can't provide more detail, but I don't want to get myself in trouble.

[GingerSue]

from my textbook:

when a client is extremely suicidal the first priority of care is client safety (diagnosis is high risk for violence, self-directed related to acute suicidal state, a desire to kill oneself as a solution to problems, an increased risk of suicide in the future)

[steelcityrn, RN]

Yes I agree....safety is top priority. You cannot treat the pain if you have no patient.

[MB37]

Actually, I lied - I meant Risk for suicide, not Risk for self-directed violence. Suicide would be the higher risk. They said the same stuff in didactic, I just wanted to make sure I wasn't doing the care plan wrong since our instructor is also bad at answering e-mails in a timely fashion.

[elkpark]

"Self-directed violence" is really a more accurate and useful descriptive term than suicide" -- lots of people do themselves v. serious injury without intending to kill themselves. The intent of the self-injurious behavior doesn't matter as much as the risk of danger, period.

You're right -- although "risk for" dxs are a lower priority in most settings, and plenty of "risk for" dxs are low priority in psych settings, safety is always the highest priority in psych and, if the client is at significant risk of injuring her/himself, that's the highest priority.

[APBT mom, LPN, RN]

My instructor's told us that when we do psych care plans to look at Maslow's because it helps show you what the hirer priorities are. On our regular care plans our instructor doesn't like us to use the same NANDA over again so we don't really use Maslow's (just so we get used to doing different rationales and interventions) in this case unless we're stuck between two.

[Daytonite, BSN, RN]

I would tend to agree that a Risk for Self-Directed Violence trumps pain on a care plan if there is active treatment for it going on.

There is nothing wrong with posting S/S of a patient on a forum. It does not identify the patient in any way unless you also list their name!

[MB37]

Oh, they just told us that we aren't to discuss our psych patients with anyone, even if we don't mention names or any identifying characteristics. They even warned us not to go home and tell our spouses about our days in general terms. I'm sure I wouldn't get in trouble as long as I was vague, but since I only had a pretty simple questions, I thought I wouldn't risk it. Thanks all, and I went ahead and submitted the assignment so now it's too late to go back.