case study help (prioritizing)

Pink Magnolia, BSN, RN · Jan 9, 2014

Is that the order you think it should be? You should go by the ABCs. Airway breathing circulation and there's also D for disability (movement, consciousness). That's what I was taught but I'm still learning too;)

Esme12, ASN, BSN, RN · Jan 9, 2014

Without know anything about your patient it is impossible to know what would be a priority. Care plans are all about the patient. Tell me about your patient ans we can go from there.

nurseprnRN, BSN, RN · Jan 10, 2014

i am currently an LPN student and this is my first case study and i had to come up with 5 NANDAs but i am stuck on the prioritization. please help
this diagnoses are :
ineffective breathing pattern rt altered respiration rate aeb chest pain
excess fluid volume rt compromised regulatory system mechanism aeb +1 edema
ineffective tissue profusion rt interruption of blood flow aeb altered LOC
impaired physical mobility rt weak left side aeb slow gait
decreased cardiac output rt change in heart rhythm aeb EKG showing a fib

There is no such thing as "a NANDA." Say, "a nursing diagnosis."

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" in nursing diagnosis means "caused by." So saying that someone has ineffective respiration because he has altered respiration and you know he has this ineffective respiration because he has chest pain really doesn't hang together.

You also cannot make up a nursing diagnosis. "Nursing diagnosis" doesn't mean, "A nurse thought this sounded right." Nursing diagnoses are evidence-based and validated with defining characteristics in the same way that, oh, the medical diagnosis of anemia has a particular meaning based on lab values.

More than that, to make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. You cannot make them up because they sound good to you. Looking in the NANDA-I

I find "ineffective breathing pattern," which has specific diagnostic criteria (like the labs for anemia) and not one of them is chest pain, and not one of the causative factors is altered respiration. So you can't say that.

There is no such nursing diagnosis as "ineffective tissue perfusion (check the spelling)," though there is "risk for decreased cerebral tissue perfusion." Risk-for diagnoses are every bit as real and actual as any other; most of them are found in the "safety" domain, and of course safety is a nursing priority every time. What is it that you assessed about this patient that made you think he had a risk for decreased blood flow to his head? If that's not what you were thinking about, what was it about him that made you think that something was amiss? Was he confused (acute? chronic?)? Drowsy? Delirious? Obtunded? What caused this? Did he have a stroke?

"Impaired physical mobility" is a real nursing diagnosis. Its defining characteristics do include slowed movement, and causative factors include neuromuscular impairment, so that would seem to apply if he had a stroke. You would write that as, "Impaired physical mobility related to neuromuscular impairment (stroke), as evidenced by weakness on left side and slow movement."

"Decreased cardiac output" is a real nursing diagnosis. Lots of people have odd rhythms and normal cardiac output, so what are you assessing that tells you why his is down?

Get the book. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!