Help- Prioritization of nsg dx help needed

Published

Trying to do an important care map tonite and study for a major test tomorrow. Had a horrid day at clinical and cried my eyes out. Now I am stuck and unsure.

I worked up the following dx for a hypothetical pt scenario we were given and have them in the following order and would like some input as to wether I have prioritized them correctly please.

Ineffective tissue perfusion- cardiopulmonary

impaired gas exchange (is this redundant with the above dx?)

impaired skin integrity r/t surgical intervention

deficient fluid volume

imbalanced nutrition

acute pain

Hyperthermia (temp 99)

please understand that these are not the whole dx and workups, just a quick list trying to save time and explanations.

Thanking all in advance!

Up Vote Up Vote ×
Trying to do an important care map tonite and study for a major test tomorrow. Had a horrid day at clinical and cried my eyes out. Now I am stuck and unsure.

I worked up the following dx for a hypothetical pt scenario we were given and have them in the following order and would like some input as to wether I have prioritized them correctly please.

Ineffective tissue perfusion- cardiopulmonary

impaired gas exchange (is this redundant with the above dx?)

impaired skin integrity r/t surgical intervention

deficient fluid volume

imbalanced nutrition

acute pain

Hyperthermia (temp 99)

please understand that these are not the whole dx and workups, just a quick list trying to save time and explanations.

Thanking all in advance!

It is hard to say because you didn't say what the patient's medical issue is but I like your top two if they are actual and not going to be risk for dx. I would put gas/airway issues first though (Airway, Breathing then Circulation). Acute pain has to be in the top 3 and some would argue it is number one if the abc's are not grossly unprotected. I would change the hyperthermia to a risk for infection dx. It is more all encompassing and will show that you are thinking of possible future problems. Imbalanced nutrition should be last out of this list. Impaired skin integrity pretty close to last. Again though, without having the data myself this is just a quick idea of what seems right based on the dx's you chose.

Up Vote Up Vote ×
Specializes in LTC, Nursing Management, WCC.

Hi,

Impaired gas exchange:

NANDA Definition: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolarcapillary membrane. (It deals with the lungs/respiratory and the impaired gas exchange of oxygen and carbon dioxide in the lungs)

Ineffective tissue perfussion (specify)

NANDA Definition: Decrease in oxygen resulting in failure to nourish tissues at capillary level. (Involves body systems like renal, cerebral, GI, etc.)

Your NICs and NOCs will be different.

It would be pretty hard to help with nursing dx unless we know the symptoms.

I think you can chuck hyperthermia for a 99 temp. Unless the person always runs at 97 and now is at 99, might be something to watch. Normally watch at 100.2 for the typical person.

Up Vote Up Vote ×
Specializes in LTC, Nursing Management, WCC.

PS... sorry you had a bad day. Remember to breathe! ;)

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.

there's a few i would switch around. . .

  1. impaired gas exchange (is this redundant with the above dx? no)
  2. ineffective tissue perfusion- cardiopulmonary
  3. impaired skin integrity r/t surgical intervention
  4. deficient fluid volume
  5. imbalanced nutrition
  6. hyperthermia (temp 99 - this is ok, look at the definition of this diagnosis and the defining characteristics. it doesn't specify what the elevated temperature must be, only that it is elevated above normal.)
  7. acute pain

Up Vote Up Vote ×

Thank you so much! My brain was just about to exlpode last night and I could barely function! I ended up putting it all away and looking back at it this am before class and it was much clearer.

I know it was hard without the background to help, and I appreciate the help I did get. I use NANDA's latest book for nursing dx and it helps, but priortization can be hard. Instructor said she usually does not have a problem with priority, esp if we can back it up.

These care maps are all new and hard to get down at first. We had another lecture this morning and we are all learning about including our instructors. I really am liking the concept better than the care plans, just a lot more work. BUT.... it covers the whole person, not like the small care plans we have been doing that cover such a small portion.

Anyhow, I just got in new Mosby software that builds care maps and will try it out when I re-do this tonite or tomorrow. I loaded it on my old desktop and it just locked up but could be this system. I will let you all know how I like it.

Take care and thanks again!

Kukukajoo

PS- had a better day today despite getting my lowest test grade ever (many in class failed so I feel lucky).

Up Vote Up Vote ×
Specializes in LTC, Nursing Management, WCC.

  1. hyperthermia (temp 99 - this is ok, look at the definition of this diagnosis and the defining characteristics. it doesn't specify what the elevated temperature must be, only that it is elevated above normal.)

hyperthermia is actually specifically defined.

definition: "hyperthermia: the state in which an individual has or is at risk of having a sustained elvation of body temperature greater than 37.8c (100f) orally or 38.8c (101f) rectally due to external factors."

carpenito - moyet, l. j. (2002). nursing diagnosis: application to clinical practice (11th ed.). philadelphia: lippincott williams & wilkins.

also;

"elevated body temperature can be either fever or hyperthermia. fever is a normal response in which the core body temperature increases at least 1.5° to 2.0° f (0.8° to 1.1° c) above an individual's normal temperature (>100.5° f [>38° c])..."

a defining characteristic is

"1. fever: core body temperature elevated at least 1.5° to 2.0° f (0.8° to 1.1° c) above individual's normal temperature (>100.5° f [>38° c])

2. hyperthermia: body temperature above 104° f (40° c) with flushed or hot skin, increased respiratory rate, and tachycardia"

http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_039.php

special considerations are given to the elderly, who sometimes have a lower core temp d/t decreased body mass.

thanks

Up Vote Up Vote ×
there's a few i would switch around. . .

  1. impaired gas exchange (is this redundant with the above dx? no)
  2. ineffective tissue perfusion- cardiopulmonary
  3. impaired skin integrity r/t surgical intervention
  4. deficient fluid volume
  5. imbalanced nutrition
  6. hyperthermia (temp 99 - this is ok, look at the definition of this diagnosis and the defining characteristics. it doesn't specify what the elevated temperature must be, only that it is elevated above normal.)
  7. acute pain

daytonite, i was just curious... i tried rearranging them myself before reading on to see if i could do it correctly. i ended up with them in the same order as you did except for the acute pain. why wouldn't it be #3 and go above impaired skin integrity? it has always been stressed to us that pain is the top priority once the abc's have been addressed.

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.
hyperthermia is actually specifically defined.

definition: "hyperthermia: the state in which an individual has or is at risk of having a sustained elvation of body temperature greater than 37.8c (100f) orally or 38.8c (101f) rectally due to external factors."

carpenito - moyet, l. j. (2002). nursing diagnosis: application to clinical practice (11th ed.). philadelphia: lippincott williams & wilkins.

also;

"elevated body temperature can be either fever or hyperthermia. fever is a normal response in which the core body temperature increases at least 1.5° to 2.0° f (0.8° to 1.1° c) above an individual's normal temperature (>100.5° f [>38° c])..."

a defining characteristic is

"1. fever: core body temperature elevated at least 1.5° to 2.0° f (0.8° to 1.1° c) above individual's normal temperature (>100.5° f [>38° c])

2. hyperthermia: body temperature above 104° f (40° c) with flushed or hot skin, increased respiratory rate, and tachycardia"

http://www1.us.elsevierhealth.com/evolve/ackley/ndh7e/constructor/careplan_039.php

special considerations are given to the elderly, who sometimes have a lower core temp d/t decreased body mass.

thanks

you are quoting from authors and secondary resources. i was quoting from nanda, the taxonomy, the primary resource. i would default to the taxonomy. granted, carpenito (now married and known by the surname moyet) is a member of nanda and has been very active in nanda. however, you are quoting from her own work, not the official publication of nanda. she is giving her own opinions and expanding on what nanda is saying.

how are you going to diagnose a patient who has temps hanging around 102 degrees? how do you classify what a person's "normal" temperature is if you don't have the medical record information? also, an "at risk" cannot be classified as an actual problem but as a potential problem.

Up Vote Up Vote ×
Specializes in med/surg, telemetry, IV therapy, mgmt.
Daytonite, I was just curious... I tried rearranging them myself before reading on to see if I could do it correctly. I ended up with them in the same order as you did except for the acute pain. Why wouldn't it be #3 and go above impaired skin integrity? It has always been stressed to us that pain is the top priority once the ABC's have been addressed.

I'm aware that many nursing instructors are doing this. Go with what your nursing instructors are telling you to do and move and sequence this diagnosis to a higher priority.

However, in classifying by Maslow, pain is a comfort need and ranks in the lower end of the physiological needs, not up at the top. That is why I rank it lower.

Up Vote Up Vote ×
+ Join the Discussion