Help with care plan

[RavensNation]

I'm doing my very first care plan and i'm so confused. My patient has pancreatic cancer, but she was admitted to the hospital with obstructive jaundice and abdominal pain. my instructor helped me out with a few nursing diagnoses and we only have to pick our priority diagnosis to write a care plan on. Below are some of the diagnoses she helped me come up with. In lecture I've always been told if there isn't an airway issue than pain is always priority, but my clinical instructor says Risk for electrolyte imbalance r/t patient receiving chemotherapeutic medications is my priority but i don't understand how that is true since its a potential problem not an actual problem and her pain is an actual problem. Let me know what you think, am i way off base here?

• Acute pain r/t biliary stent surgery a.e.b patient rates pain 6 out of 10
  
• Risk for electrolyte imbalance r/t patient receiving chemotherapeutic medications
  
• Risk for decreased liver function r/t increased bilirubin level of 13 a.e.b yellowing of patient skin and eyes
  
• Risk for falls r/t unsteady gait
  
• Activity intolerance r/t pain a.e.b patient unable to get out of bed, pain rating 6 out of 10
  

[Esme12, ASN, BSN, RN]

Now how do you decide priority? a simplistic way to look at it is what will kill them first.

Most program support Maslow's Hierarchy of Needs.

This hierarchy suggests that people are motivated to fulfill basic needs before moving on to other, more advanced needs. This hierarchy is most often displayed as a pyramid. The lowest levels of the pyramid are made up of the most basic needs, while the more complex needs are located at the top of the pyramid. Needs at the bottom of the pyramid are basic physical requirements including the need for food, water, sleep, and warmth. Once these lower-level needs have been met, people can move on to the next level of needs, which are for safety and security.

As people progress up the pyramid, needs become increasingly psychological and social. Soon, the need for love, friendship, and intimacy become important. Further up the pyramid, the need for personal esteem and feelings of accomplishment take priority. Maslow emphasized the importance of self-actualization, which is a process of growing and developing as a person in order to achieve individual potential.

Hierarchy of Needs

[h=3]Five Levels of the Hierarchy of Needs.....[/h] There are five different levels in Maslow’s hierarchy of needs:

1. Physiological Needs
   These include the most basic needs that are vital to survival, such as the need for water, air, food, and sleep. Maslow believed that these needs are the most basic and instinctive needs in the hierarchy because all needs become secondary until these physiological needs are met.
   
   
2. Security Needs
   These include needs for safety and security. Security needs are important for survival, but they are not as demanding as the physiological needs. Examples of security needs include a desire for steady employment, health care, safe neighborhoods, and shelter from the environment.
   
   
3. Social Needs
   These include needs for belonging, love, and affection. Maslow described these needs as less basic than physiological and security needs. Relationships such as friendships, romantic attachments, and families help fulfill this need for companionship and acceptance, as does involvement in social, community, or religious groups.
   
   
4. Esteem Needs
   After the first three needs have been satisfied, esteem needs becomes increasingly important. These include the need for things that reflect on self-esteem, personal worth, social recognition, and accomplishment.
   
   
5. Self-actualizing Needs
   This is the highest level of Maslow’s hierarchy of needs. Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others, and interested fulfilling their potential.
   

[nurseprnRN, BSN, RN]

Besides the irreplaceable NANDI-I 2012-2-14, I'm going to recommend two more books to you that will save your bacon all the way through nursing school, starting now.

The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current nursing diagnoses and includes several that have been withdrawn for lack of evidence.

The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

Let this also be your introduction to the idea that just because it wasn't on your bookstore list doesn't mean you can’t get it and use it. All of us have supplemented our libraries from the git-go. These three books will give you a real head-start above your classmates who don't have them.

[RavensNation]

Thanks