Need help with prioritizing NANDA's

[Chrissy55]

I need help trying to priortize my five NANDA's. Any help would be great. My five NANDA's are deficent fluid volume r/t diarrhea, fever, and decrease in intake of nutrients; diarrhea r/t effect of medications and possible infectious process secondary to C. diff; acute pain r/t inflammation of joints and surgical repair of shoulder in feb 09; imbalanced nutrition-less than body requirements r/t decrease in appetite and biological factors; and disturbed sleep pattern r/t inability to stay asleep and periodic limb movemnets.

I dont know if diarrhea should be first then deficient fluid volume and then imbalanced nutrtion and then acut pain because the pain is only occasional and not a huge factor in the pt.

Pt is elderly came in with dehydration and weakness, had been expericing bouts of diarrhea on and off and was found to have a UTI and possible C. diff infection. please help me thank you

[aerorunner80, ADN, BSN, MSN, APRN]

Deficient fluid volume would be my priority. The body functions on fluids and lytes and if they're not there, bad things happen.

[Daytonite, BSN, RN]

nursing diagnoses are merely labels for nursing problems which are patients needs. use maslow's hierarchy of needs to prioritize the list. all of your 5 diagnoses are physiological needs which makes the prioritization somewhat easy. the physiological needs, in order of need, as you have them, are for fluid, food, elimination, rest, comfort. you can read about maslow's hierarchy of needs here: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

1. deficient fluid volume r/t diarrhea, fever, and decrease in intake of nutrients (physiological need for fluid)
   
   • fever, per se is not the cause of a loss of fluids. profuse diaphoresis from fever will cause loss of fluids.
     
   • the related factors for this diagnosis focus on what causes loss of fluids. a "decrease in intake of nutrients" is not really a loss of fluids. it is just a lowered intake of fluid replacement and that is not loss of fluid. this belongs with your imbalanced nutrition-less than body requirements diagnosis.
     

[*]imbalanced nutrition-less than body requirements r/t decrease in appetite and biological factors (physiological need for food)

• decrease in appetite is evidence of this problem and not a related factor, or cause
  
• you need to describe more specifically what the biological factors are (they would be some pathophysiology of the diarrhea or uti that are causing the patient not to eat enough
  

[*]diarrhea r/t effect of medications and possible infectious process secondary to c. diff (physiological need for elimination)

• are you saying the diarrhea is a side effect of a medication?
  
• does this patient have c. diff or not? if not, just say "possible infectious process in intestinal tract" but i would not identify any organism--it creates confusion to anyone reading the diagnosis
  

[*]disturbed sleep pattern r/t inability to stay asleep and periodic limb movements (physiological need for rest)

• inability to stay asleep and periodic limb movements are a symptoms/proof (defining characteristic) not a related factors, or causes, of this diagnosis
  
• the definition of this diagnosis is a disruption in amount and quality of sleep that impairs functioning. things like anxiety, depression, noise, too much light in the bedroom, the bedroom is too hot or too cold, or the kind of medication the person takes are the types of r/t (related factors) or causes of this diagnosis
  

[*]acute pain r/t inflammation of joints and surgical repair of shoulder in feb 09 (physiological need for comfort)

• i would re-word "surgical repair of shoulder in feb 09". it sounds more professional to say "surgical intervention into shoulder __ weeks ago"