priority nursing diagnosis

  1. I have 4 diagnosis, all great ones. How do I decide what order they are in. I've been using maslow heirarchy but honestly, sometimes I feel it's a matter of opinion. When these care plans are graded, I wish there was an explaination sheet where we can express our thoughts as to why we decided to go with the ones we chose. That way if an instructor sees what is going through our minds, maybe we can get better instruction as to why our thought process is wrong. Maybe I'm way off base here though.

    At any rate, here are my 4 diagnoses that I am ranking in what I think is the order of most importance here.

    1.Health seeking behaviors r/t postpartum recovery and adaption.
    2.Deficient knowledge in infant care r/t lack of exposure to circumcision care.
    3.Readiness for enhanced family coping r/t adaption to new family member.
    4.Effective breastfeeding r/t basic breastfeeding knowledge.

    My mom (maybe you read this from another post) is picture perfect. Scheduled c/s went great, completely normal recovery. She's a mom of 2 girls (never had a boy - therefore doesn't know about circ care). Breastfeeding going great. Asking questions about how the girls will handle new baby (maybe that should be higher one the priority list). I have health seeking behaviors as #1 cuz this is focus more on her and this is HER care plan. #2 as deficient knowledge cuz the poor gal was a little nervous about the little guys peepee.:spin: (I was too with my first boy after 3 girls so I know what it's like!) #3 she was asking quite a few ?'s so maybe this should be higher?? #4 She was having no problems b/fing nipples weren't traumatized at all yet, milk was just starting to come in.

    I'm confused. See how I'm thinking? I'm constantly going over it again in my head with 'well, maybe this.' or 'what if' or 'but it could be this...' What are your thoughts??

    Also earlier in one of my posts, I had asked about a psychosocial nsg dx. The health seeking behaviors would be one right? I've always thought to myself that a psychosocial dx had to deal with feelings. It's always worked for me in the past. now I'm realizing it has to be more sometimes.

    ARGGG! there's a reason my name is struglinstudnt!!!
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  2. 7 Comments

  3. by   Altra
    Quote from struglinstudnt
    I have 4 diagnosis, all great ones. How do I decide what order they are in. I've been using maslow heirarchy but honestly, sometimes I feel it's a matter of opinion.
    ...

    At any rate, here are my 4 diagnoses that I am ranking in what I think is the order of most importance here.

    1.Health seeking behaviors r/t postpartum recovery and adaption.
    2.Deficient knowledge in infant care r/t lack of exposure to circumcision care.
    3.Readiness for enhanced family coping r/t adaption to new family member.
    4.Effective breastfeeding r/t basic breastfeeding knowledge.

    ...

    I have health seeking behaviors as #1 cuz this is focus more on her and this is HER care plan.

    ...

    Also earlier in one of my posts, I had asked about a psychosocial nsg dx. The health seeking behaviors would be one right? I've always thought to myself that a psychosocial dx had to deal with feelings. It's always worked for me in the past. now I'm realizing it has to be more sometimes.
    Hi Struggling ... a couple of things to think about:

    All 4 of the dx you listed in your post are psychosocial - none concern the physiological health of your patient. Are there any nursing dx you can apply? Think about her physiological health first - remember ABCs and then go from there. Remember Maslow, as you mentioned ... any nursing dx concerning mom's physical health will be a higher priority than the psychosocial dx you have listed here.

    HTH
    Last edit by Altra on Nov 25, '06
  4. by   mysterious_one
    I am a first sem student, I haven't done Ob , but I am wondering, even though you said the C-section went fine, and I am speaking also from personal experience here, shouldn't there be something in your care plan addressing her pain, and her incision (wound healing, tissue integrity),and other post op related diagnosis. Those to me should be addressed before any healthseaking issues, but maybe I am wrong.
  5. by   RNmom08
    ok. There is always acute pain as she had a cbirth. However, that would be my priority nsg dx and my issue with that is the pain really wasn't that bad according to her, she seemed more concerned with health seeking and circ care. My priority dx is the one that I have to expand on with 6-7 interventions, goal, goal outcome, evaluation of goals. I don't feel that applying ice to her incision and giving her pain meds would be enough for me to expand to that great of detail.

    Am I making this harder than it needs to be?
  6. by   decartes
    Risk for impaired gas exchange r/t surgery? Risk for Infection? Skin integrity? Got to get some real problems on the care plan.
  7. by   Altra
    I understand what you're saying ... that for this assignment you need a "meaty" nursing dx that you can come up w/a bunch of interventions for. However, your patient has had abdominal surgery -- there are physiological needs to be addressed here, and those always trump psychosocial needs (remember your Maslow). How does her incision look? What about the lochia? Any urinary or bowel issues? Pain control? Mobility impaired at all?
  8. by   Daytonite
    wow! i am so impressed with the replies some of you other students have given here! i'm going to add to the chorus and just mention one time that with a c-section you should have at least one nursing diagnosis that addresses the incision, lochia, and potential for postop hemorrhage and/or infection. and, i think i mentioned that to you in your other post that i responded to. however, this is your care plan. you are the only one who has spoken with your instructor and knows what is wanted for the assignment.

    so, with that said, this is how i would prioritize the nursing diagnoses you have listed by maslow. at the end of each of your diagnoses i have put, in brackets, where they are classified on the maslow pyramid which determines their order of priority:
    1. effective breastfeeding r/t basic breastfeeding knowledge [physiological]
    2. deficient knowledge in infant care r/t lack of exposure to circumcision care [safety]
    3. readiness for enhanced family coping r/t adaptation to new family member [love and belonging]
    4. health seeking behaviors r/t postpartum recovery and adaptation [self-esteem]
    happy care plan writing! hope this clears up a lot of the confusion you had about the prioritizing.
  9. by   twowingsup
    You said that she had a c/s a priority nursing dx is: Risk for infection related to surgical incision as evidence by abdominal incision. Also: Pain related to surgical procedure. your client did just have an operation and is probably in pain. Review your assessment findings. it seems that you are understanding the nursing process but need to look a little more holistically at your patient. good luck in school :+)

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