Prioritizing nursing diagnoses

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Specializes in Critical Care: Cardiac, VAD, Transplant.

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

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I'd go with deficient fluid volume. With a low volume things can take a turn for the worse rather quickly. Pain is important but in this case in my opinion the fluid defict takes president. Yes, you need to control pain but you need to stabalize the body first.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

Which one, if not corrected, could potentially kill the patient?

That's not to say that the pain isn't important, it is. Anything potentially life-threatening is more important.

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I know it's not your original question, but I'm a little concerned about your AEB's. They should correspond to the nursing diagnoses, not to the R/T's.

In other words, for #1, what S/S do you see that let you know the pt is experiencing fluid volume deficit? For #2, what evidence is there that the patient is in pain (like the pt's rating on a pain scale or physical indicators of pain like grimacing or V/S changes)?

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I know it's not your original question, but I'm a little concerned about your AEB's. They should correspond to the nursing diagnoses, not to the R/T's.

In other words, for #1, what S/S do you see that let you know the pt is experiencing fluid volume deficit? For #2, what evidence is there that the patient is in pain (like the pt's rating on a pain scale or physical indicators of pain like grimacing or V/S changes)?

I agree with Eric, and always follow ABC's: what will kill them first?

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Fluid balance should be the #1 nursing diagnosis. An imbalance in fluid and electrolytes can cause a plethera of problems with the cardiac and renal systems just to start with. While pain is definitely a problem, it is not going to do the most damage for the patient at this time. When trying to decide which diagnosis to list first, think about which one would cause the most harm to the patient if the problem were not resolved. I hope this helps.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

You need to prioritize by what your nursing instructors have told you to use as your guideline in prioritizing. Maslow's hierarchy of Needs is the most common way diagnoses are prioritized. By Maslow your diagnoses would be prioritized as:

  1. Deficient Fluid Volume (food/nutrition need)
  2. Chronic Pain (comfort need)

I have noticed, however, that some nursing instructors are telling students to put pain diagnoses as a top priority for the reason you have listed, the reason for hospitalization or primary treatment. That's why I say you need to clarify this with your instructors.

Also, let me clarify something about your nursing diagnostic statement. It IS worded correctly and I have no criticism of it. The related factor for Deficient Fluid Volume needs to be the etiology (underlying cause) of the fluid loss and that would be loss of fluids through the GI tract specifically because of frequent loose stools. 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. This refers to dehydration, water loss alone without change in sodium" (page 90, NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008).

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Specializes in Critical Care: Cardiac, VAD, Transplant.

Thank you to everyone for your advice. Our instructor tends to place emphasis on pain but I feel that the fluid volume deficit should be first. I was working with a group of other students as we were reviewing our careplans together when we had this discussion. Due to the overwhelming consensus, they have altered their order of priority to list fluid volume as primary followed by chronic pain. Currently our instructor is going out of town and will be unavailable until after careplans are due. **thanks again for advice on our structure. We have had NO instruction regarding proper form for nursing diagnoses other than what has been gleaned from our Ackley book on our own time. Too much to do and too little time! I am sure we'll have more questions before this semester is over:uhoh3:.

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It IS worded correctly and I have no criticism of it.

We're going to have to agree to disagree on this one. The presence of excessive/watery/liquid stools is a related factor (as opposed to a defining characteristic or "AEB") for deficient fluid volume in every nursing diagnosis resource that I can find.

While we can certainly highly suspect dehydration in this patient, we don't know anything about intake or other forms of output. Defining characteristics for the actual diagnosis (as opposed to a risk diagnosis) are things like decreased urine output, decreased skin turgor, dry mucous membranes, etc.

To think of it another way, once we see the frequent stools stop, is the fluid imbalance resolved? Not necessarily... that's why these other indicators make for much stronger AEB's.

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Help! Which would come first:

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

This is the list of prioritizing we were given.

1. ABC

2. Change in LOC

3. Change in VS

4. Unstable (or change) Metabolic Disorders

5. Pain

So, as far as you question goes, our instructors WOULD say the fluid volume is your first priority.

Good luck, check with your instructor. I would email him/her even if you know they are out of town. They might check your email.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

bookworm1. . .in the very back of your ackley/ladwig nursing diagnosis book are two appendixes. appendix a is "nursing diagnoses arranged by maslow's hierarchy of needs". appendix b is "nursing diagnoses arranged by gordon's functional health patterns". take a look at the maslow's triangle that is printed on page 1325. it tells you the sequencing from bottom to top of the priority of needs. off to the right side is the breakdown within each level by priority. for physiological you will see the listing is: oxygen (this includes the abcs), food, elimination, temperature control, sex, movement, rest, comfort (where i classify pain).

here is an article that has more description of the breakdown of what is in the various levels of maslow: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

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deficient fluid volume is reflective of one's circulation (abc's).

medically speaking, it is definitely first priority.

leslie

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