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Discussion

Knowledge Deficit as a priority diagnosis?

Hey everyone,

I am in my Mother/Baby rotation in my 2nd to last semester and I am stuck. My pt is japanese, speaks little english and has no prenatal education, postpartum knowledge nor knowledge of newborn care. Parents are in Japan, married to military man who works a lot so she is doing a lot of the work. We were told in school that the priority diagnosis is the "one that could kill them the fastest." Well, I truly feel her knowledge deficit of newborn care (not knowing how to breastfeed, how often, inability to recognize hunger cues of the newborn, inability to know when to change the diaper (AEB dried stool on his rear with reddened skin) and being a first-time mom with no grandparents/family to help) is her priority and could potentially "kill" the newborn, but not her. With interventions, a lot of it is assessing her knowledge, encouraging her to perform newborn care, assisting with the care as needed and teaching her how to properly bathe, position for breastfeeding, and change the diaper.

Although my heart says Knowledge Deficit of Newborn Care as her priority, I feel as if the instructor may not think that is a priority over Acute pn r/t her C-section incision and her Risk for Infection, etc. Please advise!

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    Part of setting priorities is justifying your decision. I think you can make a good case for making this diagnosis. The other ones count too, and don't just go for the low-handing fruit of knowledge deficit, risk for infection, and pain. Remember the mother-baby dyad is your patient, not just the mother. Look at some of the other diagnoses regarding bonding, breastfeeding, and coping, and see if she/they meet the diagnostic criteria to allow you to make that diagnosis. Also, look at her cultural aspects-- she's far from her traditional supports, so that could be big.

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    My OB instructor hammered one thing into us repeatedly. I was always taught that first nursing dx for a postpardum woman is risk of hemorrhage. That is what will kill her first. Consider maslows hierarchy. 2nd would probably be risk of infection if she has no other health concerns. 3rd might be knowledge deficit. But if you consider that her acute pain may be unmanaged if you don't address it, how likely is she to be able to learn? People in acute pain aren't great at concentrating to learn new info. It depends how you approach it. I'd bounce ideas off of your instructor and get her feedback.

    Good luck!

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    Don't tell anybody but think Maslow's hierarchy of needs.

    She'll think you're Einstein Jr.

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