Care plan prioritization question!!

[k1p1ssk, BSN, RN]

I have two nursing diagnoses and am having a hard time deciding how to prioritize them. They are:

Acute Pain r/t gastrointestinal irritation

and

Nausea r/t gastrointestinal irritation

Any input as to what should be the priority, let me know, thanks!

[missE]

I have two nursing diagnoses and am having a hard time deciding how to prioritize them. They are:

Acute Pain r/t gastrointestinal irritation

and

Nausea r/t gastrointestinal irritation

Any input as to what should be the priority, let me know, thanks!

pain is always of highest priority

[k1p1ssk, BSN, RN]

thank you!

[Idaho Murse]

Um, I sort of disagree with the pain is always the highest priority. This is sort of reading into it but if they have nausea r/t GI irritation and their pain meds are oral. Oral pain meds will make nausea worse, and if it induces vomiting you have defeated your oral pain meds, and made it worse because I guarantee you they are not going to be happy campers then. I would need more information before I could make a call honestly.

[k1p1ssk, BSN, RN]

the patient had 6 episodes of vomiting over 12hours, was on IV push dilaudid and 2 IV antiemetics. He had not vomited in 4 hours at the time i was caring for him, but he was still experiencing 5/10 abdominal pain and nausea. the abdominal pain had progressively gotten worse and that is why he went to the ED. the nausea and pain were caused by the same thing.

i had previously been discouraged from using pain as a priority on another care plan, hence looking for opinions!

[CCL RN, RN]

When I did my care plans I never included pain as one of my priority nursing Dx. Unless I was desperate... there is always more to the story. I think of pain and infection as "easy" ways out...

Pain causes pain. There are cases wher pain can cause more harm, such as prevention of deep breathing, thus causing PNA, or prevention of ambulation, thus causing a dvt.

Nausea and vomiting affects acid base balances, can cause dehydration, possible aspiration, nutritional imbalances, etc.

Between the two, I'd pick nausea/vomiting as a much higher priority.

What's causing the pain and nausea??? Focus on that. Obstruction, Disease processes, bleeding ulcer, gallbladder...etc

[Idaho Murse]

I am not telling you how to do your nursing diagnosis, but pain is bad yes, you can help with pain. But why are they having the pain what is the patho causing the pain. If you can do something along those lines then perhaps it will relieve their pain. Now if they just have some ideopathic chronic pain that is one thing. I would be more looking at the cause of the pain. Also dilaudid can cause nausea.

I just want to say I am not saying your pain dx is wrong. There are just other factors. Is the pain from a SBO? Necrotic intestines? AAA? Celiacs?

[missE]

given the minimal information that was presented previously, i am always going to assess and figure out what is causing the pain. both diagnosis' can be interchangeable but one of my main concerns is patient comfort. if my patient is not comfortable, that can cause an increase in pain. the nausea and vomiting can be related to the pain that the patient is experiencing but acute pain should be a major consideration. if u cant treat the pain that can cause worse off problems. i am not saying that i will ONLY just treat the pain.. s that will just hide the underlining cause of the pain.. i would assess what is the cause of the pain and how long the pain has been lasting and possible factors that led to the reason why they began vomiting.. a

[Codjonaub]

If you treat the pain with meds and the patient has nausea, likely they won't keep down the med. However, pain is a priority.