Care plan priority list help..... Please :)

[squishy11]

Hi all.. I jsut wanted to check to see if my list of diagnosis are in the correct priority. I am a little confused because in my last semester I was told that a "RISK" diagnosis NEVER comes bfore and actual.. but I have seen some risks diagnosis come beofre actuals in a few different books. So now I am a bit confused... can anyone let me know if this list looks like it is in the correct order?

1) ineffective airway clearance r/t retention of secretions AEB non productive cough

2)ineffective breathing pattern r/t respiratory muscle fatigue AEB shortness of breath

3)Impaired gas exchange r/t ventilation-perfusion AEB hypoxemia

4)Imaired cardiopulmonary tissue perfusion r/t decreased hemoglobin in blood AEB dyspnea (or could I write AEB decreased hemoglobin level on lab?)

5)Impaired physical mnobility r/t lower limb weakness AEB pt states legs feel weak when standing

6)Activity intolerance r/t imbalances betqween oxygen supply and demand ARB exertional discomfort (also.. is this the same as the cariopulmonary?)

7)Acute pain r/t inflammation of lung tissue AEB pain is a 6 on a scale of 1-10

8)Risk for deficient fluid volume r/t diarrhea

9)Risk for falls r/t generalized muscle weakness

10)Risk for injury r/t altered clotting factors

Thanks for any help in advance... I have 5 of these written up, but I am worried about the priority... Like I said - I was told that the RISKS always go last -- but it seems like a Risk for deficient fluid volume should be a little higher in the list...

Thanks again all.. and Happy Nursing!

[ACNP 2B S1S2RRR]

Well, I am not sure if that is exactly right, but that's how I've been prioritizing my NANDAs and my teachers have all been happy with my work. The only thing that I've been doing differently is incorporating my "risk" NANDAs into Maslow's pyramid behind the actuals. For example, if your pt was at risk for Aspiration, I'd put that NANDA behind ineffective airway clearance and if you're supposed to address the first 3 NANDAs and provide them with a list, I would just skip over the risk NANDA but incorporate it into the list to show that I knew how to apply the NANDA to Maslow's. I know, it does get confusing! I don't know for sure if I'm doing this right, though.

Also, you might want to find evidence to support the actual NANDA so that the risk NDx is no longer needed. That's how I usually avoid this problem. For example, you could change the risk for fluid volume Deficit to an actual if the pt's BUN and Creat values were out of whack, if the pt's Hct was high, if his urine was dark yellow or appeared cloudy (careful with the cloudy--this is also indicative of UTI), and if you observed tinting when assessing turgor above his collarbone. You could also confirm a fluid volume deficit NDx by looking at the oral mucosa--mucous membranes would be dry rather than moist. By the way, your pt is also at risk for falls r/t orthostatic hypotension secondary to narcotic analgesic use (BP drops by ten points in EITHER systolic, diastolic, or both values) aeb BP "x" while supine and BP "y" upon standing/when in high fowler's, pt reporting vertigo with ambulation, pt reporting SOB with changes in position. With such a NANDA, you'll want to make sure that you teach the pt to change positions slowly to avoid sudden drops in BP and vertigo. You'll want to keep the pt's bed in lowest position and make sure that the call light is in reach. This pt will need to call the nurse before attempting to ambulate.

If he is on diuretics (lasix/furosemide, thiazides), this would also put him at risk for fl vol deficit. You could also compare the 24 hour intake to the output, and if the output is higher than the intake, this might be an actual.

Hope this helps :)

I am pretty sure that safety NANDAs always go at the very top, even above the ABC's, but my instructor did not want me to cover "Risk for Injury" in my careplan but I did prioritize it as one of the first NANDAs, and she said that I prioritized them right.

I feel your pain! I'm working on my newborn care plan right now. Will you follow-up and let me know what your instructor said about this issue? Could help me in the future :)

Good luck!!

[squishy11]

Thank you for your help ... The care plan is due the 13th, and we will get it back the following week .. I will let you know what I have come up with and how it went :)