Having a tough time ranking Med Diagnosis

[soon2bim]

HI.

I am not sure if anyone can guide me, or not.

In my class we are to rank the medical diagnoses and write to the 4 primary.

My problem is trying to determine the 4 that are most critical to the patient.

I have a pt this week with:

Osteoarthritis, hypothyroidism, HTN, Meniere's Disease, GERD, hyperlipidemia, Herpes Zoster, and depression.

I am inclined to rank the top 4 as this:

Meniere's disease, because pt exhibits dizziness and risk for falls (none noted in this facility, however was the reason for initial admit).

Osteoarthritis, limited range of motion in joints and this impacts her mobility.

I am just stuck after that. I start talking myself into each being more important than another.

Is there something I should look for, meds, labs, etc. Anything that will possibly help?

Thank you in advance

[augigi, CNS]

I'm sure Daytonite will be along with great advice, however I'd say as a rule to start with actual problems and ABCs, and I would rank as:

1. Herpes Zoster

(If your patient is contagious, and in severe neuralgic pain, this would be their biggest problem I would think).

2. Hypertension (actual physical problem present, which would be made worse by their HZ pain)

3. Hypothyroidism (needs treatment with throxine supplementation, actual problem as opposed to risk of problem)

4. Osteoarthritis (pain, immobility)

Keep in mind, I'm not an expert at care plans, but after 10 years ICU experience, those are what I'd worry about, in order.

[soon2bim]

HI.

What you have mentioned makes complete sense. I don't know why, I always seem to think of Risk for, before actual like you mentioned in your comments.

Thank you!

Charlene

[emtb2rn, BSN, RN, EMT-B]

What're your pts current s/s? I try to figure out what medical problem is the biggest threat to the pts life and/or ADL and go from there. Pain is always a contender. Does the GERD impact the pts ability to eat? Is the HTN under control? How bad is the osteoarthritis?

Also, have you checked a dx guide like Doenges?

Good luck.

[Daytonite, BSN, RN]

Well, this is kind of a new way of prioritizing to me. Nurses rank by patient's problems, not by medical diagnoses. So, just going through your list of medical diseases and thinking about the major nursing problems connected with them, I come up with this:

• Osteoarthritis (pain and difficulty with mobility)
  
• Hypothyroidism (fatigue, dry skin)
  
• Hypertension (diet)
  
• Meniere's Disease (problems with balance)
  
• GERD (heartburn connected to diet, possible vomiting or aspiration)
  
• Hyperlipidemia (diet, no immediate effects)
  
• Herpes Zoster [shingles] (pain!, skin infection)
  
• Depression (extreme sadness, self-care deficits)

However, you're the only one who knows what the actual symptoms of these patients were. Did your instructors during lectures of nursing process mention how you were to determine priority sequencing. There are two commonly used scales: Maslow or Gordon. Sequencing these by Maslow, I would list the top four as:

1. Hypertension (because of dietary restrictions)
   
2. GERD (also because of dietary restrictions as well as danger for aspiration)
   
3. Herpes Zoster (because of the nature of being an infection and likelihood of variance in fever)
   
4. Meniere's Disease (because of problems with balance affecting movement and potential for falling)

However, I could be wrong!

On Maslow's scale the priority of sequencing physiological needs goes in this order: oxygen, food, elimination, temperature control, sex, movement, rest, comfort

[soon2bim]

HI.

That is probably why I am so confused, because that is the medical diagnosis. We have to look at textbook definition, doctors orders, client symptoms and write to the disease. The first medical diagnosis we write to, in more detail, the next 3 are to sort of feed into why that is the primary medical diagnosis.

I had a brief chat with my instructor and she said look at the meds first, there are many for pain. Her first instinct was Osteoarthritis as well.

Thank you for your advice,

Charlene

[Daytonite, BSN, RN]

By all means, go by what your nursing instructor wants. However, I must say I do not understand the rationale of what she is asking you to do and I have been a hospital nurse for 30 years.