Nanda priorities

[Karolyte]

Hello all,

I am in a great need of your help. I'm working on my care plan and here I came up with 7 nursing diagnoses and I am having a hard time to prioritize them.

This is what I came up with:

• Deficient fluid volume r/t active fluid volume loss as evidenced by frequent loose and watery stools, and decreased skin turgor.
  
• Diarrhea r/t infectious process caused by C.Difficile bacteria as evidenced by constant passing of liquid, unformed stool and positive stool culture.
  
• Bowel incontinence r/t loss of rectal sphincter control as evidenced by constant dribbling of stool, fecal staining of bedding and red perianal skin.
  
• Imbalanced nutrition: less than body requirements r/t psychological factors as evidenced by lack of interest in food.
  
• Acute confusion r/t fluid volume loss as evidenced by misperceptions and fluctuation in level of consciousness.
  
• Impaired tissue integrity r/t moisture as evidenced by loose, liquid stools, physical immobility and age.
  
• Impaired mobility physical mobility r/t physical restraint as evidenced by limitations on physical range of motion.
  

Does this seem right? My patient has cdiff and also has dementia and schizophrenia. Your help is very appreciated!

[jelly221,RN, MSN]

My most helpful (care plan -wise) instructor told me to look at causes and results when prioritizing dxs. If one of your dxs is causing the other (diarrhea causing deficient fluid volume) it would be a higher priority, because resolving that problem would resolve the sequelae.

Diarrhea and Bowel Incontinence seem a bit redundant, no?

If the pt's perianal area is red and excoriated, maybe consider a dx about Skin Integrity?

And since some of the pt's problems are caused by CDiff, what about Infection? (I know NANDA technically says "Risk for infection"... but I've had every single instructor tell me that Infection was an acceptable nursing dx).

Hope that helps!

[LadyinScrubs, ASN, RN]

First thing to do to get a nursing dx is to look at your pt. Do an assessment and go through the chart. You build a nursing dx on the problems the pt has or is at risk for---then you go to the nursing dx book and start pullilng out any/all potential dx's. Finally, you start reading the parameters of the dx. Does the pt's s/s fit the dx? If it does, then use it if it does not, get rid of it.

Question: how do you know your pt's accute confusion is related to fluid loss? I/O: how much has been lost, how much has been replaced. Is there a deficit? What does the labs reveal--lytes, H/H. How is the turgor? Are the pt's eyes sunken, mouth dry, and is there intense thurst. Is the patient's confusion so much that the pt is unable to drink or recognize thirst? Is the pt receiving fluid replacement if so what.

Skin impaired: What is the info to prove impaired skin. Is the skin red, or what? Or are you talking about a risk of skin integrity ?

Read the nursing DX book and find out exactly what nanda diagnosis will match your pt's s/s, labs, fluid in/out, etc. Then prioritize your dx's by the ABC--airway, breathing, circulation--this includes heart rhythm as well as the quantity/quality of liquid within or not in the system.