nursing diagnosis list -order

  1. I am doing my nursing diagnosis list for a major care plan
    ok, I have this knowledge deficit diagnosis,(my pt is diabetic) I know that normally this would go way down at the end, but what if I have a bunch of risk for diagnosis , do I list those first, and than the actual knowledge deficit diagnosis, ( this one is not a risk for , it is actual), or do I put that one before I start with the risk for...

    the risk for diagnosis are: risk for ineffective breathing pattern,risk for infection, risk for tissue perfusion, risk for constipation, and risk for powerlessness, that's the order I put those in

    I don't have any problems with my other actual diagnosis, I am just not sure where to put the Knowledge deficit diagnosis

    any help would be appreciated , thanks
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    About mysterious_one

    Joined: Jan '06; Posts: 582; Likes: 36
    from US
    Specialty: 7 year(s) of experience in med/surg/telem., charge nurse, preceptor


  3. by   Daytonite
    Under Maslow, Knowledge Deficit would be classified as a self-actualization need (need for facts). So, generally, it goes near the bottom of the list of the actual nursing diagnoses (problems).

    As for the anticipatory diagnoses, you classify them the same as you would other diagnoses in order of priority, but within their own block at the end of the diagnoses list. So. . .
    1. risk for ineffective breathing pattern (anticipatory physiological need for oxygen)
    2. risk for tissue perfusion (which tissue? the sequence is brain, lung, heart, other tissues) (anticipatory physiological need for oxygen)
    3. risk for infection (anticipatory physiological need for homeostasis)
    4. risk for constipation (anticipatory physiological need for elimination)
    5. risk for powerlessness (anticipatory self-esteem need for a sense of independence)
  4. by   mysterious_one
    it was tempting to put the knowledge deficit at the bottom of the list after all the at risks for, but it just didn't seem right . Especially since it is for a diabetes pt.
  5. by   toriphile23
    I am just curious on tissue fast does our brain shuts down when there's not enough O2? what bout lungs and heart too?
  6. by   Daytonite
    Quote from toriphile23
    I am just curious on tissue fast does our brain shuts down when there's not enough O2? what bout lungs and heart too?
    This is basic anatomy and physiology. It is also taught in basic CPR class. Haven't you taken anatomy yet? Didn't you have to get CPR certification before starting nursing school?
    Last edit by Daytonite on Mar 20, '07
  7. by   toriphile23

    yes i did take cpr class before starting school, and yes it's a basic anatomy and physiogy and i have taken both classes before. but i don't remember being taught how many seconds or mins or hour it takes for the brain to shut down w/out O2.

    if i know the answer, i wouldn't have asked, would i?
  8. by   calhoun220
    Maybe you should read this post before posting any questions.
  9. by   Daytonite
    when the heart goes into cardiac arrest the brain is deprived of oxygen because there is no blood circulation going on at that time. it takes about two minutes for the oxygen in the blood that is now trapped in the cerebral arteries because of asystole (no beating of the heart) to be used up by the surrounding brain tissues and cells. this is why cpr must be started quickly. after 4 minutes of cardiac asystole those oxygen deprived brain tissues begin to die. this brain damage is irreversible. if circulation is not re-established within 4 to 6 minutes of asystole the chances of surviving without some kind of brain damage due to anoxia is almost nil. beyond that, survival is very tentative at the least.

    this is why the circumstance of someone who is choking is so critical. in cpr training we are taught that the airway must be cleared of an obstruction before any chest compressions to restore circulation can be started. until then, the rescuer has to work on clearing the airway of the obstruction first so that the person will be able to take in air and oxygen into the lungs. when this cannot be done, the patient will lose consciousness as the brain uses up whatever oxygen is available in the brain cells and being brought to them by the circulating blood. once the heart stops beating, it takes about two minutes for brain cells to use up the oxygen that is available. brain cell death (infarction) proceeds next. after 7 or 8 minutes of asystole resuscitation is usually not possible.

    if oxygenation of the brain is not restored, it won't matter if other organs of the body are getting oxygen or not because death is imminent to us without a functioning brain. irreversible cellular death and tissue necrosis due to hypoxia in the heart begins to occur after about 20 minutes of ischemia caused by the blockage of one of the coronary vessels. the result is a myocardial infarction (heart attack). depending on the extent of the tissue involved, the patient can either die due to massive infarction or recover and heal if the area of cardiac infarction is not too large. infacted heart tissue is no longer able to carry out it's function. without enough functioning cardiac tissue the heart cannot sustain adequate circulation. for this reason, if one of the clot-busters is appropriate to the situation and can be administered (ex: tpa), it needs to be done within 30 minutes in order to abort the impending mi. infarcts of pulmonary tissue are rare. it is probably because of the intense vasculature of this organ. if one branch of a vessel shuts down there are plenty more to pick up slack.

    when a patient under our care gets into a situation of choking, having cardiac arrhythmias, respiratory arrest or cardiac arrest, it is critical that we understand why quick action is called for to preserve their life. this information can be found in anatomy and physiology textbooks, pathophysiology textbooks, and should also be in the materials given out at cpr classes. our textbooks should always be kept to be used as references long after a class has ended.