Nursing diagnosis priority list

[mysterious_one, ASN, RN]

every semester we have to do one major care plan: we have to pick a pt. and write Nd to each system with care plans. I am stuck at making the appropriate priority list (order).

Just an overview on my pt:

chronic renal disease, HTN, anemia

here is my list, I came up with:

1. ) Decreased cardiac output R/t Altered preload/after load

2.) Imbalanced nutrition, less than body requirements R/T Fatigue, nausea and vomiting in past 2 weeks

3.) Fluid volume excess R/T Compromised regulatory system

4.) Self care deficit (bathing, toileting) R/T Fatigue / bed rest

5.) Activity intolerance R/T imbalance between oxygen supply and demand (impaired erythropoietin production/ renal function)

6.) Pain, acuteR/T headache

7.) Disturbed sensory perception (tactile) R/T Accumulation of serum nitrogenous subst.

8.) Ineffective management of therapeutic regiment R/T failure to adhere to treatment plan and seeking timely health care

9.) Risk for ineffective airway clearance R/T Fatigue

10.) Risk for infection R/T Invasive lines

11.)Risk for falls R /T Weakness and recent history of dizziness

12.) Risk for Powerlessness R/T chronic illness

Also, I would like some input with the "activity intolerance" ND. I am not sure, if I should put it under cardiac or respiratory. Then again impaired erythropoetin production, which is renal, I am stuck there, too. Thanks for your help

[Daytonite, BSN, RN]

i think your sequencing is fine. activity intolerance relates to the patient's energy to complete adls, not his oxygen requirements although the etiology of the intolerance is because of an imbalance in oxygen supply and demand. when in doubt, read the definitions of the nursing diagnoses in a nursing diagnosis reference (i'm giving you two links that are on the internet) to get a better understanding of what these nursing diagnostic titles represent. [color=#3366ff]activity intolerance http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=01

however, there are problems with the construction of some of your nursing diagnostic statements. . .

2.) imbalanced nutrition, less than body requirements r/t fatigue, nausea and vomiting in past 2 weeks

"fatigue, nausea and vomiting in the past 2 weeks" are defining characteristics (symptoms) and are actually aeb items, not related factors. this statement should be imbalanced nutrition: less than body requirements r/t _____ aeb fatigue, nausea and vomiting in the past 2 weeks. and, actually, none of these aeb items are actually listed as defining characteristics for this diagnosis. ([color=#3366ff]imbalanced nutrition: less than body requirements). it would probably be more appropriate to use the nursing diagnosis of nausea r/t ____ aeb nausea and vomiting in the past 2 weeks. if this person's fatigue is so overwhelming, consider using the diagnosis of fatigue as well. i counted your use of the word "fatigue" three times in three different nursing diagnoses. [color=#3366ff]fatigue

6.) pain, acute r/t headache

headache is not a related factor of acute pain. acute pain is related to injury agents that are biological, chemical, physical or psychological. in other words, your related factor should be the underlying cause of the pain. a headache is a type of pain and does not even belong in the nursing diagnostic statement. what does belong with the aeb items are the patient's symptoms of their pain, so that your diagnostic statement should read something like this: acute pain r/t traumatic fracture of hip [the cause of the pain] aeb patient's verbal report of pain at 7 on a scale of 10, irritability, restlessness and grimacing [the patient's symptoms or responses to the pain]. [color=#3366ff]acute pain [color=#3366ff]chronic pain

8.) ineffective management of therapeutic regiment r/t failure to adhere to treatment plan and seeking timely health care

again, these are not related factors for this diagnosis, but defining characteristics of it so that it should be written as ineffective therapeutic regimen management r/t ____ aeb failure to adhere to treatment plan and seek timely health care [the patient's symptoms or responses to the pain]. [color=#3366ff]ineffective therapeutic regimen management

9.) risk for ineffective airway clearance r/t fatigue

again, fatigue is a defining characteristic, or symptom, the second time you've mentioned fatigue. this is an anticipated problem so the patient cannot have any symptoms. you can have an idea of what you think the symptoms of the imagined problem might be in your mind, but you never state them in the nursing diagnostic statement. you do state the risk (related) factor for them, however. the risk (related) factor for this diagnosis is almost always going to be something that is causing secretions or something else to obstruct the airway in some way. look at the related factors for ineffective airway clearance to help you get this one correct. [color=#3366ff]ineffective airway clearance your nursing interventions will be to monitor for or prevent the symptoms from occurring.

[mysterious_one, ASN, RN]

Thank you very much, I always appreciate your input.

I have actually seen the ND: Pain, acute R/T headache ,stated in

" Ackley" . I wasn't quite sure what to use there, because I can only assume where the headache in my Pt. came from, he was not sure as what brought it on. It could be because of high blood pressure or because of dialysis, stress or anything. As to the others, I agree to some of your statements, I have used some of these before. Our instructors don't require us to do a three part ND. So we are usually ok with it this way.

[Daytonite, BSN, RN]

Hey! It's your grade. Whether you use a two-part or three-part nursing diagnostic statement, you still should be basing the related factor on the etiology of the problem and using a nursing diagnosis reference to make sure you are using appropriate etiologies that go with that particular nursing diagnosis. You can't just make this stuff up. It is actually based on the NANDA taxonomy whether your instructors are stressing that or not. My feeling is do it the right way in the first place. Impress your instructors which how scholarly you are and how much you understand about this stuff. Between you and me, we might know more than them--maybe.

As for Ackley and the headache thing, where did you see that? I'm looking at page 67 of my copy of Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig under their listings for headache and I'm not finding that. Under headache they are suggesting using Acute Pain r/t lack of knowledge of pain control techniques or methods to prevent headaches. And on page 884 headache is not listed as one of the related factors for this diagnosis. Maybe you were looking at something different.

[mysterious_one, ASN, RN]

Hey! It's your grade. Whether you use a two-part or three-part nursing diagnostic statement, you still should be basing the related factor on the etiology of the problem and using a nursing diagnosis reference to make sure you are using appropriate etiologies that go with that particular nursing diagnosis. You can't just make this stuff up. It is actually based on the NANDA taxonomy whether your instructors are stressing that or not. My feeling is do it the right way in the first place. Impress your instructors which how scholarly you are and how much you understand about this stuff. Between you and me, we might know more than them--maybe.

As for Ackley and the headache thing, where did you see that? I'm looking at page 67 of my copy of Nursing Diagnosis Handbook: A Guide to Planning Care, 7th Edition, by Betty J. Ackley and Gail B. Ladwig under their listings for headache and I'm not finding that. Under headache they are suggesting using Acute Pain r/t lack of knowledge of pain control techniques or methods to prevent headaches. And on page 884 headache is not listed as one of the related factors for this diagnosis. Maybe you were looking at something different.

It is listed in different places in the front , for example under Meningitis or Postpartum care. I do have an older version of Ackley, or I would give you the page numbers.