Need help prioritizing my concept map

Thank you so much I was confused with the risk for aspiration because she has a PEG tube, that dosent make a difference does it? The pt is semi comatose, so it was hard coming up with some of the diganosis for sexuality, neurosensory, and ego.....thats why I went with thought process disrupted, sexual dysfunction and dignity, risk for compromised....soes that sound about right??

i'm sorry this is my first concept map so im learning as i go here is teh full report i did: (thank you so much for helping me :) i have been working on it for 8 hours now..lol i hope this is what you meant...

pt is npo has a g tube

medical alert: random blood sugar w/accu check q6h

medication allergies: iodine, ibuprofen, motrin

penicillin reaction: hives

diet allergy: iodine

environmental allergies: pollen reaction: runny nose

dust reaction: runny nose

age: 77

weight: 130lbs

marital status: her son has power of attorney

presenting issues: dx: vomiting, (rule out) r/o ugib (upper gastrointestinal bleed)

reason hospitalized: 77 yo female who had reported from the extended care facility of vomiting coffee grinds emesis with no diarrhea, abdomen distended, skin warm and dry

procedures: endoscopy on 10/15/09 was done torule out upper gastrointestinal bleed. there was evidence of a severe la grade d erosive esophagitis in the distal esophagus (esophagitis is inflammation that damages tissues of the esophagus, the muscular tube that delivers food from your mouth to your stomach.) often causes painful, difficulty swallowing and chest pain. causes of esophagitis include stomach acids backing up into the esophagus, infection, oral medications and allergies. treatments for esophagitis depend on the underlying cause and the severity of tissue damage. if left untreated, esophagitis may change the structure and function of the esophagus.

pt. has a replacement balloon peg that was gently moved back and repositioned, and the external flange was tightened. (percutaneous endoscopic gastrostomy) is a procedure to place a tube through the abdominal wall and into the stomach. a gastrostomy tube or a (g tube) provides an alternative feeding site. it may be needed to: feed a person who has a hard time sucking or swallowing or drain the stomach of acid and fluids that have built up.

other symptoms: pt was also found impacted & was manually disimpacted

pt also has a nasal cannula 2 lpm (f2r)

patient history: pt. suffered a left thalamic hemorrhage last year and has had language difficulty since then. she has a ct (computed tomography) which showed an old hypodensity in the left thalamus as well as white matter chronic changes, she has normal site and hearing and is occasionally confused. she incontinent for bowel & bladder

she also has diabetes, acute renal failure, parkinson's disease, hypertension, dementia w/ depression, unstable angina, breast cancer w/ a left mastectomy, osteoporosis, history of pancreatitis, cva,(cerebral vascular accident) arthritis, tonsillectomy

last vital signs: t: 97-p: 70- r: 20- b/p 142/88

skin assessments: she has a stage ii pressure ulcer in the sacrum area, and is having foam dressing applied

patient is at risk for: dvt waiting on order from the physician for scd's for dvd prophylaxis also is at risk for another pressure ulcer according to braden scale

diet: npo

iv's: d5/0.45 saline 1000ml, rate 10ml/hr around the clock until dc'd

& a saline lock per hospital policy

lab work: cmp-12 the comprehensive metabolic panel (cmp)

additional lab work: cbc w/ diff

random blood sugar w/accu check q6h

physical assessment:

loc: eye opening for verbal response, limited motor response, and no verbal response, pt is semi comatose.

no x3 to orientation of person, place or time.

general appearance: hispanic woman, chronological age & real age are comparable, religion is catholic

weight 130lbs per family

vital signs p 78, r 20, b/p 148/84, t 97.2, pulse ox 100 & shows no sign of pain

skin is pink, warm & moist with poor skin turgor, and she has a stage ii pressure ulcer on her sacral area, hygiene is poor. tongue is coated and mm are dry/pink she is edentulous and no odor

hair is straight, thin & fine & no vermin present. nails were brown, thin & brittle, convex shape, some nails were growing sideways due to hands being clenched, capillary return was normal

eyebrows were present, there was some discharge on the eyelids, sclera was white, and conjunctiva was pink

ear placement normal no hearing aids and hearing is good. nose was straight with no discharge

thorax has symmetry and was normal and clear. rate, rhythm & depth of respirations were normal.

pmi was left midclavicular and heard the 2nd intercostals space down and about 3inches to the left due to left breast mastectomy. apical rate was 74.

carotid artery was difficult to hear due to pt not being able to hold their breath, seemed clear.

popliteal was absent, posterior tibial was 1+ and dorsalis pedis was 2+

radial pulse was 78 & rate, rhythm, & strength normal.

no edema of the skin but temperature was warm, & no hair on arms or legs.

abdomen had no distention. there is a left scar on pt breast due to mastectomy and a peg tube is inserted in the stomach.

auscultates of 4 quadrants for bowel sounds were active. palpation of 4 quadrants character was soft with no tenderness or pain.

unable to inspect gait as pt is on bed rest.

symmetry of musculature normal, with limited range of motion with tight, stiff muscles. there are no amputations.

unable to do palmar grips as hands are both clenched.

pupils are equal, equal size, round and react to light.

what about impaired skin integrity?

I will change that one, from falls at risk to skin impared I have to put on NANDA in each catagory so here is what I chose:

For Activity/Rest=Mobility,impared bed

Circulation=Cardiac Output, decreased

Ego Integrity=Dignity, risk for compromised human

Elimination= Bowel Incontience

Pain/Discomfort-Pain, Chronic

Sexuality= Sexual dysfunction

Teaching/Learning= Knoeledge, deficit

Social Interation=Social Interaction imparied

Respiration= Aspiration, at risk for

Safety=Skin Integrity, impared

Neurosensory=Thought Process, disturbed

SO would they still go in the same orderof importance being that she already had a stage 2 pressure ulcer? Or wouldnt this be a higher priority? I think it should move up to number 7 and keep the others the way they are? am I thinking right?

1. Decreased Cardiac Output
   
2. Nutrition: less than body requirements
   
3. Bowel Incontinence
   
4. Impaired Bed Mobility
   
5. Chronic Pain
   
6. Bathing/Hygiene Self-care Deficit
   
7. Disturbed Thought Process
   
8. Impaired Social Interaction
   
9. Sexual Dysfunction
   
10. Deficient Knowledge, specify subject
    
11. Risk for Aspriation
    
12. Skin Integrity, Impaired
    
13. Risk for Compromised Human Dignity