priority nusing diagnosis ?

[mitchsmom]

I am just starting to do nursing diagnoses (we buy a book for it next semester and I'm not sure which one it is so I'm trying to wait)...

anyhow, what 2 nursing diagnoses should I pick/prioritize for a pt with hemiparesis, dysphagia, PEG tube, incontinent? I'm thinking something with the PEG tube and fall risk from the hemiparesis???

TIA for any help!

edit: oh yeah, that PEG tube food must really bind you up too b/c she's got orders for like a million laxatives, so constipation is an option...or is it not since she's already got the orders and doing ok now?? Same with the PEG, is she "nutrition, imbalanced, less than body requirements" or is she not since she is currently on the PEG feedings and ok? Do you know what I mean?

She also qualifies for all those self-care deficit ones, could be the sleep deprivation d/t insommnia, spiritual distress (depression), transfer ability impaired, walking impaired... OMG calgon take me away!

[Altra, BSN, RN]

weird, my online medical dictionary says difficulty swallowing for dysphagia, my Tabers says "impairment of speech resulting from a brain lesion or neurodevelopmental disorder"... in any case, she's got both but the swallowing is moot b/c she has a PEG tube now and doesn't take anything PO.

We've always given dysphagia a high priority because even if the pt. isn't taking anything by mouth, there's still a risk of aspiration of saliva/secretions, particularly in a pt. with limited mobility. Interventions that would be measurable on your shift would include monitoring of resps & O2 sats and possibly suctioning if needed.

My Taber's (19th ed.) lists dysphagia as inability to swallow. The next entry, dysphasia, is impairment of speech ...

Let us know what the teach says, mitchsmom :)

[mitchsmom]

ahem :imbar ..I think I was confusing my words... but the pt does have dysphagia and dysphasia :chuckle

and I'll remember your advice, it does make sense.

I'll get my paper back next Wednesday... the instructor will definitely let me know if she didn't like my choice.

[DeanG]

Just read the thread. I am in Sem 1 of an ADN program, we do lots of care plans. However we have to do our Nursing Diagnosis in order of the Medical Dx. so in your case if the doc listed hemiparesis as his/her first dx, then at my school, you should too. That being the case I'd go with Impaired Physical Mobility just because as a SN you can really do the interventions. Just a suggestion. Good Luck.

[Marie_LPN, RN, LPN, RN]

Anything having to do with the airway is always priority.