Please help me prioritize my nursing diagnoses for megaloblastic anemia.

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    My patient has megaloblastic anemia. During my clinical it hadn't yet been diagnosed as B12- or Folate-deficiency. My assignment is "Find 5 nursing diagnoses based on 1 medical diagnosis; prioritize those 5 nursing diagnoses in order of urgency, and create an in-depth care plan with 5-7 interventions for the top 2 nursing diagnoses."

    Listed below are my 5 diagnoses in order of urgency. Please let me know if my order is correct, or if I have a diagnosis wrong, or if I should be including a different diagnosis. For what it's worth, I'm only a 1st semester student, so please excuse my lack of knowledge. Thanks so much!

    1. Risk for ineffective tissue perfusion d/t decreased oxygen-carrying capacity of the blood.

    2. Risk for bleeding d/t decreased platelet count secondary to megaloblastic anemia.

    3. Activity intolerance r/t imbalance between oxygen supply/demand a/e/b verbal report of weakness and dyspnea.

    4. Fatigue r/t decreased oxygen-carrying capacity of the blood a/e/b reported inability to maintain usual level of physical activity.

    5. Risk for falls d/t decreased oxygen-carrying capacity of the blood.

    Additional info: Patient presented with a pale complexion and reported generalized weakness and shortness of breath for 3 days. Pertinent lab values compared to hospital standards:

    RBC: 1.62 Low
    HGB: 6.0 Low (critical)
    HCT: 16.2 Low (critical)
    MCV: 99.9 High
    MCH: 37.0 High
    MCHC: 37.0 High
    Platelets: 79 Low
    MPV: 7.9 Normal
  2. 2 Comments so far...

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    "Risk for" never come first. I would change the risk for ineffective tissue perfusion to an actual diagnosis and make it number 1 rational: ABC model. Activity intolerance and fatigue are kinda the same so I'd work on those. and I'd make the risk for falls a risk for injury: u didnt mention if the pt had any neuro or musculature problems and you can use the same interventions since they're the same diagnosis. as for the rest I would list them as follows, 1(once you edit it), 3, 4,2(rational ABC Famework and mention bleeding times if you know them), 5.

    I hope this helps
  4. 0
    i think it's a really good start for a first-year student, and as i did for someone else, i'd like to know how your faculty taught you to do this well at it so soon. judging by a lot of the confusion we see here, whatever your faculty is doing, more faculties should take note. you can tell them i said so :d.

    that said, i agree that "risk for" wouldn't often take precedence over an actual condition, but sometimes the risk of something is so serious that it could. as they say in the exams, justify your decision-- you might be right. you have identified the relevant labs for this person. she is already be low on oxygen-carrying capacity and has the signs and symptoms to go with that.

    the nursing diagnoses (as opposed to the dictionary definitions) of activity intolerance and fatigue are not really the same thing, although there is some overlap. my nanda gives them on adjacent pages, but they are not strictly equivalent. take a look at them and see if the difference between them applies to your patient.

    you can also give some thought to emotional needs (is this scary for her? it would sure as heck scare and/or depress me to be that sick) and learning/self management needs for now and the future.