Prioritization of Patients Diagnoses

  1. hi everyone,
    i'm currently completing a first year assignment and wanted to get some feedback about the 2 nursing diagnosis i've chosen to focus on for my assignment. we were supposed to pick the two highest priority problems and expand from there.
    out of:
    ineffective tissue perfusion: peripheral
    chronic pain
    activity intolerance
    ineffective health maintenance
    knowledge deficit
    risk for impaired skin integrity
    risk for peripheral neurovascular dysfunction

    out of those i chose the top two as the highest priorities.
    this relates to a (made up) patient who had peripheral arterial disease with symptoms like diminished peripheral pulses, increased cap refill time, oedema, intermittent claudication, etc.

    would anyone say i've picked the right two? he's come into the clinic specifically due to the pain that's part of the reason i chose chronic pain and i chose tissue perfusion because that relates to circulation..

    any help will be appreciated
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    About qutstudentnurse86

    Joined: Oct '09; Posts: 4
    from AU


  3. by   Daytonite
    this is how the diagnoses would be sequenced according to maslow's hierarchy of needs:
    1. ineffective tissue perfusion: peripheral
    2. activity intolerance
    3. chronic pain
    4. ineffective health maintenance
    5. knowledge deficit
    6. risk for impaired skin integrity
    7. risk for peripheral neurovascular dysfunction
  4. by   qutstudentnurse86
    THanks very much for your help, I've read up on Maslow's hierarchy but I would have thought that pain would come before activity intolerance, can you explain why you put that before pain? Is it because its not experienced all the time - only when walking?

    thanks again!
  5. by   Daytonite
    this is how the diagnoses would be sequenced according to maslow's hierarchy of needs:
    1. ineffective tissue perfusion: peripheral [physiological need for oxygen by the peripheral tissues]
    2. activity intolerance [physiological need for oxygen by the heart and lungs--during activity]
    3. chronic pain [physiological need for comfort]
    4. ineffective health maintenance [safety need]
    5. knowledge deficit [self-actualization need for growth]
    6. risk for impaired skin integrity [anticipated need for safety from physiological threat]
    7. risk for peripheral neurovascular dysfunction [anticipated safety need for protection]
  6. by   qutstudentnurse86
    oh my goodness
    i totally get it now, thank you so much i would have picked the wrong 2 priorities other wise.
    thanks again!
  7. by   qutstudentnurse86
    another question for you:

    i've chosen the two diagnoses youve recommended however i'm choosing interventions for activity intolerance now and can only come up with a walking program. any other ideas? this is what i have so far:

    activity intolerance related to decreased arterial blood flow as evidenced by intermittent claudication (and some subjective data).

    goal: patient will experience improved ability to ambulate and participate in activities without pain within 2 weeks (not sure of the time) of implementation of interventions.

    thanks for any help!
  8. by   Daytonite
    Activity Intolerance is a Respiratory and Circulation problem and has to do with deconditioning to activity and not with pain the patient is having. It has to do with the patients tolerance of activity and the way it affects the heart and lungs. Your goal should not include any mention of pain along with activity. Intermittent claudication is a symptom of the nursing diagnosis Ineffective Tissue Perfusion, Peripheral. You have probably diagnosed this problem incorrectly.
  9. by   Coop_696
    i'm doing the same task... and i'm hung up on which to interventions to use for impaired perfusion... we are only allowed 2! so far i have (and they are only basic outlines)

    1. assess for pain in the extremities, noting severity, quality, timing and exacerbating and alleviating factors. (however i assume this would be more thoroughly assessed had i used chronic pain and doesn't relate as much to this situation?)

    2. keep the client warm and have the client wear socks and shoes or slippers while mobile. do not apply heat.

    3. pay meticulous attention to foot care. (patient has thickened toenails and decreased sensitivity in toes... mb refer to podiatrist?)

    1. perform toe-up and point-flex exercises
    2. observe for signs of dvt, including pain, tenderness, or swelling in the calf and thigh, and redness in the involved extremity.

    1. note skin texture and the presence of hair, ulcers, or gangrenous areas on the legs or feet.

    (i developed evaluation criteria for each already... but i can't decide which 2 are the best to use :s)

    if anyone knows of any great literature on interventions on pad it would be appreciated

    *sigh* 2000 words on justifying why we chose the 2 top priorities, the 1 goal and 2 interventions is not fun.
    thanks in advance for any assistance
  10. by   Coop_696
    oo sorry I have another Q... does anyone know if we would be expected to incorporate a timeline for implementations (maybe find some average time frames in literature for expected outcomes)? I believe we are to assume the Pt was discharged or will be discharged in a short time frame as he is otherwise healthy and has a wife to go home to! (he states in the video we saw that he only came to the hospital as his normal Dr was away so I assume we would unlikely see him to assess him again).