How can you prioritize d/x with a pt with many complications?

[Hellostudentnurssee]

NOTE: this is not a real life patient.

I'm having trouble picking and prioritizing d/x for this patient: he has a history of cancer; was in surgery of lymph nodes, had a complication during surgery and had stroke like symptoms (as later confirmed by CT scan). He has weakness on one side, is able to speak now (had brief aphasia for a few minutes after surgery) and is now admitted for weakness and placement? (which I'm guessing is more with rehabilitating him for an acute skilled home or adult home). He has pressure ulcers in both bilateral heels and on the back. He was not in any pain.Here were my d/x:

- ineffective tissue perfusion (bc of stroke?)

- Impaired for mobility (important for safety since he's weak w. his mobility. Has referral to PTs)

- situational low self esteem ( which seemed apparent in the scenario)

- Skin breakdown (but can't say risk, acc to our professor)

- infection (can't say "risk" acc to our professor)

I need something for his post mild stroke - breathing was stable, since he is on an anticoagulant, his circulation may be at risk. What can I put for pressure ulcers? Is that important? Or is impaired mobility more important? My prof gave me a hint that she thought the low situational self esteem was important. So i just need 2 more priority d/x - post stroke, safety, skin ulcers?

thanks

[Pneumothorax, BSN, RN]

NOTE: this is not a real life patient.

I'm having trouble picking and prioritizing d/x for this patient: he has a history of cancer; was in surgery of lymph nodes, had a complication during surgery and had stroke like symptoms (as later confirmed by CT scan). He has weakness on one side, is able to speak now (had brief aphasia for a few minutes after surgery) and is now admitted for weakness and placement? (which I'm guessing is more with rehabilitating him for an acute skilled home or adult home). He has pressure ulcers in both bilateral heels and on the back. He was not in any pain.Here were my d/x:

- ineffective tissue perfusion (bc of stroke?)

- Impaired for mobility (important for safety since he's weak w. his mobility. Has referral to PTs)

- situational low self esteem ( which seemed apparent in the scenario)

- Skin breakdown (but can't say risk, acc to our professor)

- infection (can't say "risk" acc to our professor)

I need something for his post mild stroke - breathing was stable, since he is on an anticoagulant, his circulation may be at risk. What can I put for pressure ulcers? Is that important? Or is impaired mobility more important? My prof gave me a hint that she thought the low situational self esteem was important. So i just need 2 more priority d/x - post stroke, safety, skin ulcers?

thanks

Remember follow the A,B,C's if all are ok, then Maslows Hierarchy. Also nursing dx has to be something you can do and not a medical diagnosis or a risk.. (silly i know)

Seems like he has impaired circulation..

what about nutrition? is he able to eat without assistance or aspiration?

[jadedjane, ASN, RN]

When I see ineffective tissue perfusion, I think heart failure, MI, cardiomyopathy or something that has to do with pumping ability of the heart muscle or decreased circulation. What caused the stroke (HTN, athersclerosis, etc..).

Now that he's already had the stroke and his mobility is limited, skin breakdown would be a big issue, as would infection....but don't forget about nutrition either. The patient has to have adequate nutrition to heal from both surgery and pressure ulcers.

[Hellostudentnurssee]

YES! I definitely agree with you. I talked more about it with other instructors and seems to be that "skin breakdown" and "impaired mobility" would be great. Mobility is important for safety and since this pt in the scenario is admitted for placement and his discharge plans. Skin breakdown is important but how would that fit under ABC's and maslow? I'm leaning towards that as my #1 but not sure....

[xtxrn, ASN, RN]

What in the world is wrong with "risk for"????

I didn't see where the guy has an infection, but decreased mobility would increase the risk.

Skin breakdown is actual (heels, back)

:)