need help with prioritizing nursing diagnosis...

[miniangel729]

I need help with checking if the way I prioritize my nursing dx is correct..

my patient is a 4 month old female admitted for Bronchiolitis secondary to RSV -2 days ago.

has decrease PO intake for two days prior to admission (about half of what she normally takes).

she's currently stable on room air with O2 sat >94%.

needs to be yaunkuer suction x3-4 times/shift with thick moderate to large clear/cloudy/white secretion.

and deep suction sometimes before feed (~2 times/shift) with thick small/moderate cloudy/white secretion.

per mom, PO intake has improved but still not as much as before

Before 120cc q3-4 hr

Now 90-100cc q3-4 hr

baby activity level has increased, but still not as active as prior hospitalization.

baby is not receiving IVF. no s/sx of dehydration, fontanelle is flat, mucous membrane moist, good skin turgor/cap refill.

Receives RT treatment Q6H - Albuterol.

Had a temp to 39.0 axillary during last shift, resolved with cooling measures and tylenol x1.

All her CBC came back normal except Platelet was elevated - 522 (normal range 150-450) => done upon admission, so could be due to mild dehydration.. since she's been having decrease PO intake.

Mom is at bedside very loving and active in care, a bit anxious because it's her first baby, and first time being hospitalized.

so here are my diagnosis...

#1 Ineffective airway clearance R/T inflammation, excessive thickened mucus secretion

#2 Imbalanced Nutrition: less than body requirements R/T decreased appetite, fatigue, poor suckingand breathing coordination

#3 Fatigue R/T increase work of breathing (is this a proper related to? @@)

#4 Risk for fluid volume deficit Risk factor: decrease PO intake, risk for hyperthermia due to inflammation process

#5 Anxiety R/T knowledge deficit

#6 Knowledge deficit: care of patient condition r/t lack of exposure

do they sound right? priority wise..? am I missing anything?

our teacher doesn't set a limit to how many nurse dx we can have, whatever its pertinent and important needs to be on there.

and am I being redundant? I am not sure if #6 is necessary because I already mentioned about knowledge deficit in #6. and intervention will probably be the same => patient education!

thanks in advance..!! :):)

[solneeshka, BSN, RN]

I think this is a great care plan! But I don't work with babies, so I'll toss in that disclaimer :-) The only things I might change would be to add "r/t increased work of nutritional intake" to #3 (and yes, I think increased work of breathing is an appropriate r/t statement). And then on the last two, just clarify that you're talking about the mother, not the actual patient. So maybe phrase it as "Caregiver anxiety r/t..." What I remember the most about respiratory distress in babies is that they are at a significant risk for dehydration and weight loss because it takes a lot of effort for babies to eat (one reason that the sleep so much after eating) and if they can't breathe well, they have less energy and they get tuckered out trying to eat enough. You've done a very good job!