Can you help me prioritization????

prudence09 · May 21, 2009

Go with which one is the worst

1. ESRD (the kidneys are dead and the patient need some major interventions)

2. Pain

3. Physical immobility

4. Risk for impaired skin intergrity

Daytonite, BSN, RN · May 21, 2009

diagnoses are most often prioritized according to maslow's hierarchy of needs. you can read about the hierarchy here: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs. when you hear people say "think about abcs" maslow's hierarchy is one of the things they are referring to because the abcs (airway-breathing-circulation) refer to the order of importance to check the patient if they are unconscious. for maslow it is the order of importance if the patient is receiving oxygen or they will die.

i am sequencing your nursing diagnoses per the maslow hierarchy, however, there are problems with the way you have constructed some of them which i have listed by each.

excess fluid volume related to decreased urine output and retention of sodium and water secondary to chronic renal failure (esrd)
- the related factor for a nursing diagnosis must be the cause of the problem, in this case, excess fluid volume which is increased isotonic fluid retention (page 85, nanda international nursing diagnoses: definitions and classifications 2009-2011). decreased sodium output is a symptom, or defining characteristic, of this diagnosis so it cannot be a related factor. retention of sodium and water is merely restating what the diagnosis is and is telling us nothing about the cause of the patient's fluid retention. you can simple state: excess fluid volume related to renal dysfunction secondary to chronic renal failure (esrd).

[*]impaired physical mobility r/t deposition of uric acid in the joints.

the related factor for a nursing diagnosis must be the cause of the problem, in this case, limitation in independent, purposeful physical movement of the body or of one or more extremities (page 124, nanda international nursing diagnoses: definitions and classifications 2009-2011). you need o carry this a step further. how have these uric acid deposits in the joints created a mobility problem? pain in the joints? difficulty moving? stiffness in the joints?

[*]chronic pain r/t inflammation of joints secondary to gouty arthritis.

[*]risk for impaired skin integrity r/t presence of edema

you need to break edema down into its components that would cause the skin breakdown because it is not just the presence of fluid that leads to skin breakdown. see the risk factors that are listed on this page for this diagnosis: http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=48 - risk for impaired skin integrity