priority nusing diagnosis ?

lisamc1RN, LPN · Oct 19, 2004

I'm brand new at this myself, so I hope someone else chimes in! Wouldn't the dysphagia already be at least partially remedied by the tube? I'm thinking that safety would be the first thing to think of , so At Risk For Fall would be my first choice. I really don't know much about PEG tubes as yet, though. I'll keep reading other people's advice to you so I can learn, too! :rotfl:

I am just starting to do nursing diagnoses (we buy a book for it next semester and I'm not sure which one it is so I'm trying to wait)...
anyhow, what 2 nursing diagnoses should I pick/prioritize for a pt with hemiparesis, dysphagia, PEG tube, incontinent? I'm thinking something with the PEG tube and fall risk from the hemiparesis???
TIA for any help!
edit: oh yeah, that PEG tube food must really bind you up too b/c she's got orders for like a million laxatives, so constipation is an option...or is it not since she's already got the orders and doing ok now?? Same with the PEG, is she "nutrition, imbalanced, less than body requirements" or is she not since she is currently on the PEG feedings and ok? Do you know what I mean?
She also qualifies for all those self-care deficit ones, could be the sleep deprivation d/t insommnia, spiritual distress (depression), transfer ability impaired, walking impaired... OMG calgon take me away!

wonderbee, BSN, RN · Oct 19, 2004

Welcome to the world of nursing diagnoses. Risk for injury r/t (whatever the brain pathology is) as evidenced by hemiparesis would be my first one. BTW, is it right, left or global? Altered nutrition, less than body requirements r/t (name your pathology but not in medical terms) as evidenced by percutaneous epigastric feeding, might be another.

mitchsmom · Oct 19, 2004

The dysphagia is impaired speech from a stroke...so it's not remedied by the tube...were you thinking of an eating problem?

RN kitty...thanks for the welcome.. I think... :) The hemiparesis is on the right side of her body, but it's on the left on her face.

Someone in another thread below wrote that "risk for" was always the last priority so now I wonder if I should pick "fall risk"????

wonderbee, BSN, RN · Oct 19, 2004

Risk for can be your priority. For example, If you have a very drunk alcoholic admitted to a rehab, your first priority will be to keep him safe. Risk for injury would be your priority. The thing about nursing diagnoses, is that this is individualized for your patient and is YOUR plan.

You will also be learning that you are not to use medical terms like "stroke" or other medical diagnosis terms in your nursing diagnosis. Instead you will use words such as "brain event" or some other dippy stuff.

Rhoresmith · Oct 20, 2004

risk for impaired skin intergrity would be a good one, because of the hemiparesis and the tube feeding which means probably issues with electrolytes and albumin which also increase risk for skin breakdown, and saftey as everyone else says. Even with tube feeding still could have nutrition issues.......... Are you doing this on your own or is this for class? Be careful because until your school and instructors tell you how they want it you can really confuse yourself with jumping ahead on nursing diagnoises

studentnurse74, LPN, LVN · Oct 20, 2004

Do you do actual handwritten care plans, or concept maps? We do concept maps, and we are to pick the nursing diagnoses that has the most arrows pointing to it in the end. It also has to be something we can achieve in our 1 day at clinical. Like if we chose fall risk, our intervention goal would be to keep the patient safe that day. I know it's very simple, but for now they just want us to get used to these. Hope this helps!

Altra, BSN, RN · Oct 20, 2004

You might want to give priority to the dysphagia, because anything that potentially compromises the airway generally takes top priority.

Isn't this fun?? :rolleyes: :chuckle

lisamc1RN, LPN · Oct 20, 2004

Ok, dysphagia is difficulty swallowing, right? :uhoh21: I think I need to look things up more often. :chuckle

mitchsmom · Oct 20, 2004

weird, my online medical dictionary says difficulty swallowing for dysphagia, my Tabers says "impairment of speech resulting from a brain lesion or neurodevelopmental disorder"... in any case, she's got both but the swallowing is moot b/c she has a PEG tube now and doesn't take anything PO.

We do handwritten care plans but they are introductory and we just fill in a basic form for now. I remembered more that narrowed it down for me... we aren't to use "risk for" yet, just actuals, and they have to be measurable in our shift... so that narrowed it alot and I ended up using the nutrition, less than body requirements, and bowel incontinence since they were both issues when I was there and the goals could be measured on my shift (I guess we were supposed to make these goals right there that morning but I didn't). Her chart said she was bowel continent but she wasn't, so I don't know if that was new or what, another reason I picked it (a new issue).

Anyway, I think I'm done so we'll see what the teach says!! It would have been easier if she didn't have soooo many possibilities. Thanks for the help!

mitchsmom · Oct 20, 2004

oh, and I did think about the skin integrity one, I know that is often a priority but again I wasn't sure b/c it isn't currently an issue.

Same thing with breathing pattern, b/c she has COPD and O2 on her chart, but there was no issue with that when I was there (the nurse didn't even know about the COPD thing, what it was from (emphysema, asthma, etc.)..so even though it's an ABC, it wasn't happening.

I'm going to ask the teacher about that tomorrow.

lisamc1RN, LPN · Oct 20, 2004

oh, and I did think about the skin integrity one, I know that is often a priority but again I wasn't sure b/c it isn't currently an issue.
Same thing with breathing pattern, b/c she has COPD and O2 on her chart, but there was no issue with that when I was there (the nurse didn't even know about the COPD thing, what it was from (emphysema, asthma, etc.)..so even though it's an ABC, it wasn't happening.
I'm going to ask the teacher about that tomorrow.

If you aren't allowed to do At Risk For diagnoses then I would definitely do the nutrition and incontinence ones! :) I'm so glad we don't get graded on these things yet! :rotfl: Good luck tomorrow!