This is cut from another post I made on this topic:
This article is fantastic if you can find it, really helped me to clarify ND's.
Tribulski, Jean A. (1988). Nursing diagnosis: waste of time or valued tool? Registered Nurse Dec 1988, pp 30-34.
In a nutshell just in case you cant' get the article anywhere:
Example: Fluid volume excess related to excess sodium intake.
Condition (nursing diagnosis) = patient goals.
i.e. fluid volume excess = goals, weight loss, no pulmonary edema, choose low sodium items from menu.
Etiology (related to factors) = interventions
i.e. excess sodium intake = interventions, weight QAM, monitor I & O, assess breath sounds...etc.
Another example: your priority 1.
Pain related to biological injury agent (tumor)
What is the real issue here, other than pain...is the client having difficulty sleeping, moving, etc? I would put these 'nursing' things as my dx so that your goals could be "will sleep 4 hours uninterrupted", "will mobilize 3x on my shift" instead of something vague like "will decrease pain" (but this is good to have too).
Can you make interventions to make the fact that this client has cancer go away? Nope. I try to avoid using medical dx's as related to statements (but will sometimes put them in as causative factor).
Personally, I would change this one to:
Sleeplessness, anxiety, immobility, and difficulty concentrating related to pain caused by tumor.
Goals: client will sleep 4 hrs unintertrupted, client will appear to have less anxiety, client will mobilize 3x on my shift, client will have a conversation with me and not seem distracted by pain as evidenced by position changes, etc).
Interventions: medicate regularly for pain, assess pain on a numeric/qualitative scale Q2H, assist client in positioning/mobilizing to decrease pain.
As for your prioritising, I think that's great. If there's no immediate airway, circulatory problems, pain is always priority #1 because it can affect so many things. With skin breakdown there's risk for infection, with constipation there's risk for impaction.
Very sorry for the long (long) post. This is something that I really struggled with my first 2 years of school, this year I finally got it (I think *lol*) and would love to help someone else get it too ;-) It's a great feeling when a tutor/preceptor/teacher says "that's perfect" :-D
Much luck with those, keep up the good work!!