Need help with care plan

[Carla25]

This is my first semester of nursing school and it is in the summer We all know summer semsters are crammed. I am in fundamentals and doing my first care plan, and my teacher just took one day to explain it so I need some help. I need some help with prioritizing my nursing diagnosis.

I only need the top three out of these

Ø Chronic Pain related to chronic physical or psychosocial disability AEB weight changes and a verbal report. (Cox, 2002, p. 421)

Ø Constipation related to insufficient physical ability AEB decreased frequency, indigestion. (Cox, 2002, p. 199)

Ø Impaired Memory related to neurological disturbances AEB observed experiences of forgetting. (Cox, 2002, p. 416)

Ø Impaired Dentition related to ineffective oral hygiene AEB missing teeth, worn down teeth. (Cox, 2002, p. 119)

Ø Sensory perception disturbed (Visual) related to biochemical imbalances for sensory distortion AEB hallucinations, change in response to stimuli (Cox, 2002, p. 431)

Ø Nutrition, Imbalanced, less than body requirements related to inability to ingest or digest good or absorb nutrients as a result of biologic, psychological or economic factors AEB hyperactive bowel sounds, loss of weight with adequate food intake (Cox, 2002, p. 157)

Ø Impaired Physical mobility related to sensoriperceptual impairment, AEB limited ability to perform gross and fine motor skills (Cox, 2002, p. 322)

Ø Self Care Deficient Bathing-Hygiene related to neuromuscular impairment AEB Inability to get bath supplies, Inability to get water source, Inability to get in and out of the bathroom, Inability to dry body (Cox, 2002, p. 330)

Ø Self Care Deficient Dressing, and Grooming related to neuromuscular impairment AEB Inability to choose clothes, Inability to remove clothes, inability to put on socks, inability to put on shoes (Cox, 2002, p. 330)

This is what I have come up PLEASE HELP!!! It is due on Monday

THANKS!!!!!!!!!

[weirdRN, RN]

The way that I learned to prioritize was to use the ABC's and Maslow's Heirarchy of needs.

Without knowing what the scenario is and just looking at the Ndx's you have come up with, it looks like there may be some other things going on with the patient that you may have missed. You might want to post the scenario with those listed nursing diagnosis.

And did your patient have constipation with hyperactive bowel sounds?

[Antikigirl, ASN, RN]

Looking at this..think, what needs to be done right away! I think pain is a biggie, and constipation because that can quickly lead to other more serious consequences if not treated. Those would be my first two because time is of essence to control them and assess the probelms.

Then, knowing as many geris as I do...I would be working on dental because this too can have very seirous consequences! Bad oral care can lead to not only GI disturbances, weight probelms, nutrition probelms, but to fluid and electrolye disturbances, infection, and heart probelms by certain bacteria that harbor there and find their way to the valves of the heart which they love to distroy! Poor dental can help you with the nutrition one :).

Going down the list...I check for motility and cognition. These are the folks that will have you running into the room with falls, and potentially an extremely dangerous situation as well. These must be avoided so also important.

And lastly I would be doing the ADL's on a care plan...As you get to know these..these are typically always there in some degree or another. Important yes, but I don't tend to focus on these as much as other issues working in hospital settings. At the ALF I worked in these issues were handled by care plan department and I was able to help with suggestions.

I see the three I mentioned as important to deal with now, and if it is chronic I still think it is important to add in the careplan as top issues.

Others differ, but those are my choices (I am a big pain control advocate btw).

[Daytonite, BSN, RN]

first of all, does your program want you classifying your patient care data according to maslow, gordon, roper/logan/tierney, or some other listing of functional need priority that they have taught you? if so, then that is how you must arrange the priority of your diagnoses. based on the information you've given i would list your top three as (and, that is by applying maslow):

• nutrition, imbalanced, less than body requirements related to inability to ingest or digest good or absorb nutrients as a result of biologic, psychological or economic factors aeb hyperactive bowel sounds, loss of weight with adequate food intake (cox, 2002, p. 157). you won't have a patient if they are dead from not eating enough. so, this is an urgent physiological need.
  
• chronic pain related to chronic physical or psychosocial disability aeb weight changes and a verbal report. (cox, 2002, p. 421). this actually, i think, is a problem you need to address before you can do anything about all the mobility and self-care ones.
  
• constipation related to insufficient physical ability aeb decreased frequency, indigestion. (cox, 2002, p. 199). an important physiological need.

all your other diagnoses are also important except for impaired memory which is a safety issue one. safety issues take back seat to physiological ones under maslow's system.

make sure you have all the abnormal data (patient symptoms) to back up these diagnoses and nursing interactions for each data item. i am assuming that you also have to supply rationales with referencing as well. are you using a care plan book to help you out?