I am extremely stuck with an assignment. It is in two parts. In the first part of the assignment, I have to identify four nursing diagnoses with rationale and prioritisation and one patient centred goal for each diagnoses with rationale for the goal. I am stuck with which diagnoses to use and the prioritisation.
This is my scenario:
You are a registered nurse employed by a residential aged care facility to undertake comprehensive nursing assessments, develop plans of care and monitor the implementation and evaluation of this care in the facility.
Mr Bonnici is 68 years of age and was admitted to the aged care facility two days ago. Mr Bonnici speaks little English. He refuses to take his medications and is spending a lot of time lying on his bed. When approached by a staff member he speaks rapidly and loudly. Mr Bonnici has a reddened area at the base of his spine and his right elbow. He is overweight, has mild right sided weakness from a stroke (Cerebral Vascular Accident - CVA) mobilises independently with a frame and has a history of severe right sided shoulder pain. He has had no bowel actions since entering the facility.
I have had so many thoughts about this and they keep changing, that I feel unable to write the assignment.
I was thinking:
Impaired skin integrity (reddened areas - pressure ulcer) priority one
Constipation (no bowel action) priority two
Chronic pain (history of severe right sided shoulder pain) priority three
Noncompliance (refusing to take medications) priority four
Any ideas, tips, suggestions?