How to prioritize the nursing diagnosis?

[Astrid_CW]

Hi, lately my school teacher gave this exercise to us and asked us to identify and prioritize the diagnoses. Yet, I'm really struggling about the diagnosis and the prioritization. I hope someone can help.

Here is the case:

Mrs. White, 62 year old, was admitted to hospital was admitted to hospital due to difficulty in breathing and decreased general condition. She was conscious but tired-looking. She was diagnosed with chronic renal failure with CAPD care started 4 months ago.While performing health assessment, the following data was collected:

➡️ Blood pressure: 180/80 mmHg, heart rate: 120bpm, temperature: 37.0c, SpO2:

95%, respiratory rate: 28 respiration per min, body height: 145 cm, body weight:

68kg

➡️ Complete Blood Count (CBC) showed anemia, with hemoglobin (Hb) 9.3g/dL

(14.0-18.0 g/dL) and hematocrit (Hct) 32.0% (42.0-52.0).

➡️ Blood Chemistry showed sodium 131.0 mmol/L (135.0-145.0 mmol/L);

potassium 5.5 mmol/L (3.5-4.5 mmol/L); urea 22.9 mmol/L (3.0-8.0 mmol/L);

creatinine 156.0 umol/L (60.0-120.0 umol/L) and total albumin 20.2 g/L

(27.0-39.0 g/L).

➡️ Urinalysis revealed specific gravity of 1.011, gross proteinuria and multiple casts

➡️ Breathing with foul odor and scattered fine rales at bilateral lung bases.

➡️ Skin was cool and dry with some scrapes on limbs. Pitting edema also found on

bilateral lower limbs and edematous fingers and hands were seen.

➡️ Appetite poor and complained of feeling of fullness even not eaten.

➡️ She is having medications for the blood pressure control and drug adherence is satisfactory.

Here is my attempt:

1. Excess fluid volume related to decreased kidney function and compromised regulatory function secondary to chronic renal failure as evidenced by pitting edema on bilateral lower limbs, edematous fingers and hands; difficulty in breathing.

2. Ineffective tissue perfusion related to decreased cellular components required for the delivery of oxygen / nutrients to the cells as evidenced by hemoglobin 9.3 g/dL and Hct:32% and complained of difficulty in breathing and tired-looking.

3. Risk for infection related to alteration in skin integrity secondary to continuous ambulatory peritoneal dialysis.

Please help to give me some comments and correct me if my diagnoses are wrong. Thanks.

[meanmaryjean, DNP, RN]

Rule of thumb: Ask yourself "What will kill my patient the fastest?"

THAT is your priority diagnosis.

[jg0817]

Think about your ABC. Airway, breathing, circulation. By the way, is the patient's 95% SpO2 on room air?

[Sour Lemon]

ABCs, friend. I believe you have passed right over one of them.

[Natasha A., CNA, LVN]

Reference from Saunders PN 6th Edition

"Use the ABC . Maslow hierarchy of needs theory and steps of the nursing process to prioritize."

Look up posts from Daytonite on here. Great info on prioritzation

[gere7404, BSN, RN]

meanmaryjean said:

Rule of thumb: Ask yourself "What will kill my patient the fastest?"

THAT is your priority diagnosis.

THIS. Take a look again at those vitals -- something might be going on a little more urgent than risk of infection.