help with prioritizing nsg dx

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I am helping a friend revise a paper that is due tomorrow. The requirement is to come up with 5 nsg dx for a pt that we've taken care of. She has come up with the following:

1)Risk for decreased cardiac perfusion R/T hyperlipidimia, obesity, and positive family history of heart disease.

2)Actue pain of idiopathic nature AEB pt. C/O burning and heavy pressure in center of chest and rates pain 8/10.

3)Activity intolerance R/T fear of pain AEB fatigue, SOB with activity and sedentary lifestyle.

4)Knowledge deficit R/T new condition AEB questioning members of healthcare team about what causes chest pain.

5)Imbalanced nutrition: more than body requirements AEB BMI 48.2 and in the 98th percentile for age.

Here is the scenario. Middle aged woman. Had lap band a few years ago, but is still obese. Extremely sedentary lifestyle. No hx of htn but does have hx of hyperlipidemia. Takes Zocor. Also has rheumatoid arthritis. Hx of depression takes cymbalta. Admits to "eating everything in sight". Was just started on asa. I spiffed the first dx up, but I think they are out of order as far as prioritizing them. I think they're a little weak as well as far as the way they are written. Please help out. I told her I'd look this over for her! Thanks!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

there is no nursing diagnosis addressing the patient's depression. this is the sequence they should go in and the problems with the construction of the diagnostic statements:

  1. activity intolerance r/t fear of pain aeb fatigue, sob with activity and sedentary lifestyle.
    • this diagnosis is defined as insufficient physiological or psychological energy to endure or complete required or desired daily activities (page 134, nanda international nursing diagnoses: definitions and classifications 2009-2011).
    • sedentary lifestyle is the etiology (related factor - r/t) for why the patient cannot perform physical activity, not a fear of pain. if this patient has pain or a fear of pain, then it belongs with the diagnosis of acute pain.
    • the correct diagnostic statement here would be: activity intolerance r/t sedentary lifestyle aeb sob with activity and fatigue.

[*]imbalanced nutrition: more than body requirements aeb bmi 48.2 and in the 98th percentile for age.

  • where's the related factor (etiology)?
  • "admits to eating everything in sight" should be added as one of the aeb items

[*]acute pain of idiopathic nature aeb pt. c/o burning and heavy pressure in center of chest and rates pain 8/10.

  • the name of the diagnosis is acute pain. idiopathic nature is a medical decision and cannot be used in a nursing diagnosis.
  • where's the related factor (etiology)? isn't there pain because of the inflammation of the joints due to rheumatoid arthritis? what does the patient take for that? why was the asa started? if this patient has chest pain because of lack of oxygen transport to the heart tissue then a diagnosis of decreased cardiac output or ineffective tissue perfusion, cardiac need to be considered.

[*]knowledge deficit r/t new condition aeb questioning members of healthcare team about what causes chest pain.

  • the correct nanda label for this diagnosis is deficient knowledge (specify). the subject of teaching interventions needs to be stated in the diagnostic title, so this should state something like: deficient knowledge, angina.
  • the related factor (etiology) of the problem is incorrect. the cause of the patient's deficient knowledge is not that it is a new condition. it is because the patient lacks this knowledge.
  • the correct diagnostic statement here would be: deficient knowledge, angina r/t lack of knowledge aeb questioning members of healthcare team about what causes chest pain.

[*]risk for decreased cardiac perfusion r/t hyperlipidemia, obesity, and positive family history of heart disease.

  • hyperlipidemia and obesity are medical determinations and cannot be used in nursing diagnostic statements. i fail to see the pathophysiological connection between obesity and decreased cardiac perfusion. to use hyperlipidemia as a risk factor it needs to be restated in more generic wording.
  • if this patient has already had angina, she is not at "risk" for "decreased cardiac perfusion" because it has already happened. look up the pathophysiology of angina and coronary insufficiency. also, there is no nanda diagnosis of decreased cardiac perfusion. use either decreased cardiac output or ineffective tissue perfusion, cardiac.

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what if we don't know that the chest pain is cardiac. If we assume it is would "Acute pain related to myocardial ischemia AEB pt report of pain rated 8/10. Pt. says it feels like pressure on my chest and it burns". I got the impression however, that the pain may just be heartburn. Therefore it wouldn't be cardiac related and myocardial ischemia wouldn't work. Troponin I was

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Specializes in med/surg, telemetry, IV therapy, mgmt.

For heartburn use Acute Pain R/T esophageal irritation.

Yes, for long-term pain use Chronic Pain.

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but what can you say if you don't know what's causing the pain?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Make an educated guess after reviewing the medical data.

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