I'm working on my first care plan and the instructor is requiring that we have 10 nursing diagnoses, which need to be prioritized into a list using Maslow's hierarchy as our guide (physiologic, safety & security, love and belonging, self-esteem, self-actualization). I've got my 10 diagnoses, but was hoping to get some input on whether I'm prioritizing them in the right order. My patient is a 90yr old female who is in the nursing due to late effect cerebrovascular disease with dominant side (right) hemiplagia.
1. Risk for falls (hx of falls. My instructor has been placing an emphasis on this to the whole class, which is why its at the top)
2. Chronic pain (she rates it at 9 out of 0-10, which is why I put it so high in the list)
3. Feeding self-care deficit (set-up help for meals. Placed as number 3 due to food being a need for survival)
4. Impaired transfer ability (1 assist to get OOB, independently once in w/c by pulling herself up with handrails. Numbers 4-7 are physiological needs related to activity, I wasn't entirely sure which order they should be in so I put the mobility ones first since immobility affects so many body systems)
5. Impaired walking (1 assist with walker, needs to take frequent rests due to getting tired)
6. Impaired bed mobility (1 assist, positions with pillows)
7. Dressing self-care deficit (needs help with lower body and buttons)
8. Risk for impaired skin integrity (she moves around a lot and is low risk based on the Braden Scale. I could put this one higher, but figured since she's low risk it wasn't quite as important as immobility and ADLs)
9. Risk for compromised human dignity (since she needs help with personal hygiene. This is a self-esteem risk, so not as important as the physiologic needs)
10. Risk for situational low self-esteem (she said that sometimes she feels useless due to her illness and being in the nursing home. My understanding of Maslow puts self-actualization needs last, so that is why this one is on the bottom)
The care plan isn't due until the 17th (I'm working ahead on it due to having already made up my last clinical day which I will be missing next week - a friend is getting married out of state and I'm one of her bridesmaids), so I have plenty of time to change things if needed. Any input will be welcome!
(I'm typing this on my phone, which is not the easiest phone to type on, so please forgive any spelling or grammatical errors.)
