Can you help me prioritize my nursing diagnoses for my careplan?

Rocktheman · Oct 4, 2014

bump!!

LadyFree28, BSN, LPN, RN · Oct 4, 2014

Do you have a care plan book with NANDA diagnoses?

Rocktheman · Oct 4, 2014

^ i do, its the NANDA book. its for 2009 to 2011. I couldn't find anything that would relate to possible addiction risks in terms of smoking.

Carpediem1012, BSN, RN · Oct 4, 2014

Try looking at "Readiness for Enhanced Knowledge" in NANDA. That's the only hint I'm giving :)

Esme12, ASN, BSN, RN · Oct 5, 2014

^ i do, its the NANDA book. its for 2009 to 2011. I couldn't find anything that would relate to possible addiction risks in terms of smoking.

YOu should be using a more current book for the diagnosis change and are changing again This moth the new book is published they change them about every 3 years.

you prioritize according to Maslows and the ABC's.

1. Biological and Physiological needs - air, food, drink, shelter, warmth, sex, sleep.
2. Safety needs - protection from elements, security, order, law, stability, freedom from fear.
3. Love and belongingness needs - friendship, intimacy, affection and love, - from work group, family, friends, romantic relationships.
4. Esteem needs - achievement, mastery, independence, status, dominance, prestige, self-respect, respect from others.
5. Self-Actualization needs - realizing personal potential, self-fulfillment, seeking personal growth and peak experiences.

JoseQuinones · Oct 5, 2014

ABC's.

Risk for Impaired Gas Exchange would almost always take priority over any other nursing diagnosis, though I question whether that could be clinically related to smoking. It's usually something more immediate, like Excessive Secretions or Pulmonary Edema.

Pain is always a low-priority diagnosis, except in very special cases (like with right-sided heart failure, where pain can aggravate it). In this case, it would probably be either your last concern or close to it.

My dos centavos.

Esme12, ASN, BSN, RN · Oct 6, 2014

Rocktheman
1. Risk for disturbed body image related to post-partum abdominal size manifested by patient stating “I still feel fat even after the baby came out”.
2. Imbalanced Nutrition that is more than body requirements related to excessive weight gain manifested by weight gain of more than 45 lbs during pregnancy.
3. Risk for Impaired Parenting related to young age as manifested by patient being only 19 years of age.
4. Risk for Impaired Gas exchange related to patient stating she smokes as manifested by SpO2 level of 94%
5. Constipation related to pregnancy as manifested by patient not having a BM within first day of post-partum
6. Acute Pain related to right labial laceration manifested by patient asking for Motrin for pain.
7. Role strain related to insufficient finances as indicated by patient being on Medicaid.
As it is, we have to find the three priority nursing diagnoses for our care plan. I was thinking the first one be acute pain, followed by risk for impaired gas exchange, followed by Imbalanced Nutrition. Thoughts?

On what you have here...

1) risk for diagnoses do NOT have "manifested by" a Risk diagnosis: Risk for (diagnosis)_________ related to (risk factors)________ If she is making the statement it is no loner a risk because she has a disturbed body image AEB her statement.

for example the patient is At risk for a heart attack related to HTN, smoking, poor diet, elevated cholesterol, diabetes.

2) Just food for thought...while 45 pounds is not recommended...she did just have a baby...for the average female...during pregnancy

Baby: 8 pounds
Placenta: 2-3 pounds
Amniotic fluid: 2-3 pounds
Breast tissue: 2-3 pounds
Blood supply: 4 pounds
Stored fat for delivery and breastfeeding: 5-9 pounds
Larger uterus: 2-5 pounds
Total: 25-35 pounds

3) again risk for diagnosis does not have as manifested by....what NANDA resource are you using?

4) again risk for diagnosis has not have as manifested by.

6) Post lady partsl delivery...rust me is a pretty high priority

7) possibly

I don't know enough information about your patient to help you.

Esme12, ASN, BSN, RN · Oct 6, 2014

Care plans are all about the patient assessment...of the patient. Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE from our Daytonite

Assessment
(collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
Determination of the patient's problem(s)/nursing diagnosis
(make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
Planning
(write measurable goals/outcomes and nursing interventions)
Implementation
(initiate the care plan)
Evaluation
(determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1.

Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you.

What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient.

Did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list.

This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Another member GrnTea say this best......

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else.

assessment consists of gathering data about:

a health history (review of systems) - you've provided more than enough of that
performing a physical exam - you have none and this information is crucial to have
assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) you have none and we nurses are pros at adls--its what we do
reviewing the pathophysiology, signs and symptoms and complications of their medical condition - this information is needed for the etiologies on your nursing diagnostic statements
reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - what its side effects and potential complications are

Now tell me about your patient.

Esme12, ASN, BSN, RN · Oct 6, 2014

ABC's.
Risk for Impaired Gas Exchange would almost always take priority over any other nursing diagnosis, though I question whether that could be clinically related to smoking. It's usually something more immediate, like Excessive Secretions or Pulmonary Edema.
Pain is always a low-priority diagnosis, except in very special cases (like with right-sided heart failure, where pain can aggravate it). In this case, it would probably be either your last concern or close to it.
My dos centavos.

Acute pain is fith vital sign. Trust me when I tell you after a vag delivery/episiotomy/tear pain is high in the priority list.

Rocktheman · Oct 6, 2014

Thats my understanding with pain. Its a physiological sign so according to Mazlows hierarchy of needs it is certainly a priority diagnosis. I obviously did not include assessment data in my question but it is present in my careplan (did you guys assume I forgot to assess?). My patient had no real life threatening problems so acute pain related to a labial laceration could be one.

Rocktheman · Oct 6, 2014

I'm using Davis's Nurses Pocket Guide by Doenges, Moorhouse and Murr. We were told that we must have a "manifested by" for all nursing diagnoses. I'm assuming that is for risk as well, I dare not go against what our instructor said, since its pass or fail.