Help with Care Plan - Nursing Diangnosis Priority

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    Hello! I am in the middle of trying to get all my ducks in order so I can write my paper for my Care Plan paper. I, for some reason, keep getting stumped with putting my nursing diagnoses in order of priority, particularly when none of them have to do with the ABC's (airway, breathing, circulation), and when pretty much all of them are on the same level in Maslow's hierarchy of needs.

    My patient is a 47 year old female in the hospital because of a UTI. She has recently been diagnosed with colon cancer, gotten a colectomy to remove the cancer, and now has a colostomy. She is on chemotherapy so she has all that fun stuff to deal with. Low WBC's, anemia, nausea, etc... Her vitals were all fine, though her temperature went up and down a little bit, up to 100.3 at one point. She was constantly in a lot of pain ( pain level ranged from about a 5 to an 8) and on morphine for that. She has a foley now because a bladder scan showed that she had urinary retention. I came up with quite a few nursing diagnoses for her, but I am having a hard time picking the top 5 and putting them in order. Any help would be much appreciated.

    -Acute pain r/t alterations in urinary and GI systems
    -Ineffective urinary elimination r/t inflammation of the bladder secondary to medical diagnosis of UTI.
    -Ineffective protection r/t chemotherapy suppressing immune system
    -Activity intolerance r/t presence of pain and effects of pharmaceutical agents
    -Risk for infection r/t inadequate immune system
    -Fatigue r/t disease process, anemia, drug effects
    -Nausea r/t pharmaceutical agents, chemotherapy
    -Nutrition: less than body requirements r/t patient being on clear liquid diet secondary to nausea
    -Urinary retention r/t inflammation of the bladder secondary to medical diagnosis of UTI
    -Readiness for enhances nutrition r/t advancing to a normal diet
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  3. 4 Comments so far...

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    To put it bluntly, what will kill her? Those will always be priority. They may not have anything to do with ABC's, but some of the ND you listed have a potential to cause serious complications and/or death.
  5. 0
    Right. So far, my top 5 are:

    1. Acute pain ( top priority because since nothing else, if left untreated for 10 minutes, is going to cause serious harm, relieving or lessening her pain is my top priority)
    2. Urinary retention (because the retention of urine can cause abdominal pain and can cause kidney damage)
    3. Ineffective protection (she is at risk of developing more or worse infections because her immune system is impaired)
    4. Nausea (because while she is nauseous she will not be feeling comfortable and may vomit. Vomiting can lead to fluid and electrolyte imbalance. Also, if she is nauseous, she is not going to eat much, which will cause poor nutrition and lead to nutrient deficits.)
    5. Activity intolerance (if she is not moving around much, many other systems will be effected.)
  6. 0
    Think about your patient. What are the most important things to be concerned with? Think about her age and diagnosis
    1. Pain
    2. Coping- related to diagnosis and a colostomy
    3. Risk of infection
    4. Performing of ADL's - patients want to be independent
  7. 0
    Quote from LaurenG89
    Right. So far, my top 5 are:

    1. Acute pain ( top priority because since nothing else, if left untreated for 10 minutes, is going to cause serious harm, relieving or lessening her pain is my top priority)
    2. Urinary retention (because the retention of urine can cause abdominal pain and can cause kidney damage)
    3. Ineffective protection (she is at risk of developing more or worse infections because her immune system is impaired)
    4. Nausea (because while she is nauseous she will not be feeling comfortable and may vomit. Vomiting can lead to fluid and electrolyte imbalance. Also, if she is nauseous, she is not going to eat much, which will cause poor nutrition and lead to nutrient deficits.)
    5. Activity intolerance (if she is not moving around much, many other systems will be effected.)
    Welcome to AN! The largest online nursing community!

    So we can better help you.....what semester are you? What care plan book do you have? Care plans are all about the assessment of the patient and the patients needs...... You develop your nursing diagnosis from there with approved NANDA I nursing diagnosis language/definitions and related characteristics.

    Is ineffective protection, fatigue a NANDA approved diagnosis? If the patient has all of these abnormal labs....what concerns would you have? Care plans are all about the assessment of the patient....tell me about your patient


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