Can someone help me prioritize

[Queen yaya]

hi everyone,

ok now i am working on med surg care plan number 2. my patient had surgery for a distal ilea carcinoid. all of her lab values are wnl, except for one liver enzyme that is slightly elevated. she had no bowel sounds nor bm when i did my assessment. she is 24 hours postop. my diagnoses are:

acute pain r/t invasive fluid lines and surgical incision aeb patient guarding iv site and stating, "the areas around my incisions feels tight and hurts when i move."

altered bowel elimination: postoperative ileus r/t administration of general anesthesia and manipulation of bowel during surgery aeb absence of bowel sounds and patient not having bowel movement or flatus since surgery

risk for infection r/t invasive procedure

what do you think? how should i prioritize these? thanks for your eyes.

[MERRYWIDOW46]

Just how you have them 1-2-3 seems about right to me. Pain is a big issue, as is ileus, and risk of infection. How many problems do you need to adress in the care plan? Altered Nutrition secondary to NPO status? Knowledge deficit secondary to disease process and treatment? Does your patient have a NG tube or foley? Good Luck.

[Daytonite, BSN, RN]

this is how they should be prioritized according to maslow along with the reasoning, although i have to tell you that altered bowel elimination: postoperative ileus is not an official nanda diagnosis. i respect that you probably are allowed to develop your own nursing problems (diagnoses) and you did a good job on that one. ileus is a medical determination and you might get dinged for that because we have to be careful how we use medical diagnoses in nursing diagnostic statements. you might want to run that by an instructor before you turn the care plan in.

1. altered bowel elimination: postoperative ileus r/t administration of general anesthesia and manipulation of bowel during surgery aeb absence of bowel sounds and patient not having bowel movement or flatus since surgery (physiological need for elimination)
   
2. acute pain r/t invasive fluid lines and surgical incision aeb patient guarding iv site and stating, "the areas around my incisions feels tight and hurts when i move." (physiological need for comfort)
   
   • if you look at the definition of acute pain in the nanda taxonomy it clearly says it results from "actual or potential tissue damage". a surgery where the body has been cut into is a cause of tissue damage. drainage tubes are a treatment. can you explain how are they causing tissue damage?
     

[*]risk for infection r/t invasive procedure (anticipated safety need)

[DolceVita, ADN, BSN, RN]

So then bowel elimination should come before pain?

[Daytonite, BSN, RN]

So then bowel elimination should come before pain?

According to Maslow. Some instructors want Acute Pain sequenced first on surgical patients. It is best to discuss this with your instructors because it may affect your grade.

[DolceVita, ADN, BSN, RN]

Thanks! I can see how some, for post-op, would go for acute pain. We were taught bowel elimination as a priority but it just goes to show not everything is black and white.

So much to learn so little time!