Divorce, health insurance and help prioritizing Nursing Diagnosis

[cminmd]

acute pain related to surgical incision, drains and prolific abdominal infection with multiple abscesses as evidenced by patient's report of pain as 6/10, clenched teeth upon movement, grimacing and guarding.

risk of falls related to lower extremity weakness, orthostatic hypotension and patient walking bent over due to abdominal pain resulting in limited field of view.

anxiety related to traumatic medical diagnosis, financial stress and marital discord as evidenced by patient crying, snapping at family members, working while hospitalized and reporting fear over losing insurance coverage.

impaired tissue integrity related to surgical incision and invasive lines as evidenced by 6 inch midline incision, well approximated, with two bilateral drains held with sutures.

risk for infection related to large abdominal wound and drains.

nausea related to post surgical anesthesia and surgical manipulation of the intestinal organs as evidenced by patient reports of nausea after fluid intake and upon moving, anti-emetic medication and post operative abdominal agitation.

fluid volume excess related to electrolyte imbalance and impaired renal function as evidenced by edema in lower extremities and decreased and concentrated urine output.

constipation related to surgical trauma and opioid medication regimen as evidenced by decreased bowel sounds, clear liquid diet and no bm since surgery.

hi everyone, i am finally finished lurking and want to join in on the great resource that is all of you!!

my patient is a 54 yo cau, female; 3 and 4 days post op from an emergency perforated appendix. surgical report drained over 1 l of purulent fluid from many abscess thoughout peritoneal cavity. surgeon also indicated multiple growths orginating from large turmor on left kidney. referred to oncology for followup when appendix crisis has passed.

additionally, the patient is going through a divorce that will be finalized within the next month or so. despite all her physical issues she is filled with anxiety over health insurance as she is leaving her husbands plan upon disolution of the marriage- and now she has a significant pre-existing condition. how do i prioritize my list of diagnosis? what part should anxiety play and what interventions can nurses do to help? it might be easier to skip the "psych" stuff and stick to physical issues, but it really seemed like i would be ignoring her biggest issue. she was working the phones, would break into tears, would snap at family and push herself because she felt she needed to get better right away to get as much done on the cancer before the clock ran out. any suggestions?

[Daytonite, BSN, RN]

By Maslow, but keeping Pain at top since most instructors like it there:

1. Acute Pain RELATED TO surgical incision, drains and prolific abdominal infection with multiple abscesses AS EVIDENCED BY patient’s report of pain as 6/10, clenched teeth upon movement, grimacing and guarding.
   
2. Impaired Tissue Integrity RELATED TO surgical incision and invasive lines AS EVIDENCED BY 6 inch midline incision, well approximated, with two bilateral drains held with sutures.
   
3. Fluid Volume Excess RELATED TO electrolyte imbalance and impaired renal function AS EVIDENCED BY edema in lower extremities and decreased and concentrated urine output.
   
4. Nausea RELATED TO post surgical anesthesia and surgical manipulation of the intestinal organs AS EVIDENCED BY patient reports of nausea after fluid intake and upon moving, anti-emetic medication and post operative abdominal agitation.
   
5. Constipation RELATED TO surgical trauma and opioid medication regimen AS EVIDENCED BY decreased bowel sounds, clear liquid diet and no BM since surgery.
   
6. Anxiety RELATED TO traumatic medical diagnosis, financial stress and marital discord AS EVIDENCED BY patient crying, snapping at family members, working while hospitalized and reporting fear over losing insurance coverage.
   
7. Risk for Infection RELATED TO large abdominal wound and drains.
   
8. Risk of falls RELATED TO lower extremity weakness, orthostatic hypotension and patient walking bent over due to abdominal pain resulting in limited field of view.

Actual problems always get sequenced before anticipated problems. With Maslow, physiological problems are a priority over psychological ones.

[cminmd]

Thank you so much!! You are right. I need to drop down anxiety because physical needs come first!