Prioritizing nursing diagnoses

Nursing Students General Students

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Help! Which would come first:

Deficient fluid volume r/t frequent loose stools secondary to ulcerative colitis AEB bloody stools 8 - 10 x daily

OR

Chronic Pain R/t actual tissue damage secondary to ulcerative colitis AEB bloody stools, abdominal cramping

We think the Deficient fluid volume would be #1 but we were also told that pain is often the factor that leads the patient to hospitalization. In this case, because pain is chronic rather than acute, it should go second, right???

thanks,

bookworm1

Specializes in med/surg, telemetry, IV therapy, mgmt.
deficient fluid volume is reflective of one's circulation (abc's).

medically speaking, it is definitely first priority.

leslie

It depends on the etiology and pathophysiology of how the fluid loss is occurring. If dehydration were at the basis of the fluid volume deficit, yes. However, in this case it is arguable that the fluid loss is through the GI tract making it a nutrition or elimination problem since the patient is losing the fluid by frequent stools.

Also, remember that we are not speaking medically, but in terms of nursing.

It depends on the etiology and pathophysiology of how the fluid loss is occurring. If dehydration were at the basis of the fluid volume deficit, yes. However, in this case it is arguable that the fluid loss is through the GI tract making it a nutrition or elimination problem since the patient is losing the fluid by frequent stools.

Also, remember that we are not speaking medically, but in terms of nursing.

a fluid volume deficit will ultimately manifest itself w/the same outcome.

if it's not corrected, the pt will inevitably become dehydrated.

also, we're taught abc's as priorities, all of which are a medical concern.

our assessments are prioritized according to life-saving necessity, as it should be.

we will tend to the pt struggling w/breathing, sooner than the pt c/o pain.

leslie :)

The "bloody stools 8 to 10 times a day" is the patient's symptom and quite appropriate in describing the diagnosis which is "decreased intravascular, interstitial, and/or intracellular fluid.

Wouldn't blood stools 8-10/day be evidence of a risk for fluid volume deficit as opposed to evidence of fluid volume deficit?

But assuming fluid volume deficit is an appropriate nsg diagnosis...

I just referenced a book on Google in regard to assessments indicative of fluid volume deficit and they ranged from thirst and concentrated urine to decreased urine output (

If the patient were showing signs of mild fluid volume deficit, the prioritization of dealing with that would be different than if the the patient were showing signs of severe fluid volume deficit, right? Especially if the patient were in extreme pain.

An inherent problem of writing care plans ahead of time is that the patient isn't right there to assess and one has to speculate on the symptoms the patient may have based upon the patient's previous symptoms and the usual symptoms associated with the diagnoses in question.

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