Quote from aphillipi
Hello! I am working on my first care plan right now and for part of it we are to prioritize all of the nursing diagnoses we came up with from our assessment. Well I found a ton of abnormalities with my patient so I have a ton of dx's and I'm getting all mixed up with my priorities. I tried to do ABCs and then Maslows needs and put the actual dx's before risks (we were told to stay away from risk dxs but i think the 2 i have are biggies so im still going to throw them in there). anyways i would love to hear any suggestions about the order of the dx's or any of the dx's themselves.
My patient was a 70 yo female recovering from total hip replacement and small bowel obstruction due to postop mild ileus. Vitals were all within normal ranges. Thanks!!
Constipation R/T medication use and immobility AEB patient report of no BM in 5 days.
Acute pain R/T postoperative pain AEB patient reports of pain.
Impaired Tissue Integrity R/T surgical disruption of tissues AEB surgical incision on right hip.
Activity intolerance R/T reduced oxygen carrying capacity of the blood AEB hematocrit level of 32.9 and patient reports of fatigue.
Impaired physical mobility R/T pain and imposed restrictions of movement AEB limited range of motion.
Impaired skin integrity R/T shearing force of surgical tape AEB area of excoriation on right upper buttocks.
Urinary retention R/T high urethral pressure caused by disease AEB patient report of “dribbling”.
Self care deficit, dressing R/T musculoskeletal impairment AEB patient request for dressing assistance.
Disturbed sleep pattern R/T gender related hormonal shifts AEB patient report of difficulty falling asleep and staying asleep.
Imbalanced nutrition: More than body requirements R/T sedentary activity level AEB weight 20% over ideal for height and frame.
Bowel incontinence R/T immobility and medications (laxatives) AEB patient report of involuntary passage of stool.
Impaired urinary elimination, urge incontinence, R/T uninhibited bladder contraction AEB patient report “Sometimes I feel the urge and then I go before I even get a chance to get up.”
Disturbed sensory perception: kinesthetic r/t altered sensory integration and medications AEB patient report of vertigo once a month.
Risk for infection R/T surgical incision on right hip.
Risk for Acute Confusion R/T electrolyte imbalance AEB hyponatremia and hypochloremia.
Fatigue R/T poor physical condition AEB patient report “my energy level is in the cellar.”
Anxiety R/T threat to health status AEB patient statement “I’m nervous about getting another bowel obstruction.”
Ineffective coping R/T situational crisis AEB verbalization of absence of coping methods.
Impaired knowledge R/T complexity of therapeutic regimen AEB patient statement ““I do take vitamins and herbs. I can’t remember all of them.”
Impaired memory R/T neurological disturbances AEB patient reports of difficulty with “retrieval”.
Ineffective sexuality patterns R/T absence of partner AEB reported changes in previously established sexual patterns.
Readiness for enhanced self health management R/T altered health status AEB patient expresses desire to seek higher level of wellness.
Disturbed body image R/T change in appearance due to multiple pregnancies AEB patient verbalization of such changes in a negative way.
hey, this is a LOT of nursing diagnoses. i know your question asked about prioritizing but to be honest, some need to be re-written.
R/T postoperative pain AEB patient reports of pain.
....pain R/T pain AEB pain?... the etiology cannot be "pain" if the diagnosis is "pain". and you must write the patient's pain scale (0-10) as the AEB.
and you never say "caused by disease" you say "secondary to diabetes"
R/T neurological disturbances AEB patient reports of difficulty with “retrieval”.
--- i also used impaired memory for my patient and my instructor said this was incorrect based on the age and information given. difficulty retrieving what? old memories, new information?? ....if anything, this should be low on the list of priority.
Ineffective sexuality patterns
R/T absence of partner AEB reported changes in previously established sexual patterns.
---- again, this diagnosis is low priority.
in my OPINION, the highest priority on the list is Acute Pain.
i didn't see any regarding breathing or respiratory which are always highest priority.
i've been told "risks" aren't highest unless "risk for aspiration" following surgery.
ps. i'm a first semester NS student so i could be COMPLETELY wrong! haha