Need help prioritizing my nursing diagnosis.

Published

I have to do a care plan on my post partum patient who is pretty much healthy and normal.

I had to choose 4 diagnosis for my care plan the 4 i chose for my pt are

1. Risk for bleeding

2. Acute Pain

3. Impaired tissue integrity ( she had a c section)

4. ineffective Breast Feeding

Now i am having a difficult time with prioritizing them in the correct order because some say all "actual" nursing diagnoses have priority over any "risk for" diagnosis. But then i keep thinking and I feel like the "risk for bleeding" has priority over acute pain because my initial response would be to assess for hemorrhage or impending hypovolemia as well as preventing hemorrhage before taking care of the acute pain. I cant figure out the best way to sequence these diagnoses, please help.

Up Vote Up Vote ×

i put this in the wrong place and cant delete the post:no::unsure:

Up Vote Up Vote ×

You don't "pick" or "choose" a nursing diagnosis. You MAKE a nursing diagnosis the same way a physician makes a medical diagnosis, from evaluating evidence and observable/measurable data. YOU assessed your patient, and YOU get to diagnose her, and YOU get to choose the priorities because YOU know what she needs most.

This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

A nursing diagnosis statement translated into regular English goes something like this: "I'm making the nursing diagnosis of/I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological."

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2015-2017 (current edition). $39 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. This edition also includes an EXCELLENT FAQs section aimed at students.

NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

If you do not have the NANDA-I 2015-2017, you are cheating yourself out of the best reference for this you could have. I don't care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from Amazon. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. CONGRATULATIONS! You made a nursing diagnosis! :anpom: If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

About Risk for” diagnoses:

First: "Risk for" nursing diagnoses are very often properly placed first, as safety ranks above all of the physiological needs in Maslow's hierarchy. What are nurses for if not to protect a patient's safety?

Second: It is a fallacy that "risk for..." nursing diagnosis is somehow lesser or not "real." If you look in your NANDA-I 2015-2017, there is a whole section on Safety, and almost all of the nursing diagnoses in that section are "risk for..." diagnoses. However, because NANDA-I has learned that nursing faculty is often responsible for this fallacy, the language on these has recently been revisited and was changed to include "Vulnerable to ..." in the defining characteristics the current edition.

Third: This sort of assignment is often made not only to see if somebody can recite rote information but to elicit your thought processes and see how well you can defend your reasoning.

So, what is the reasoning you have applied to your ranking, as applied to a specific patient or to people in general?

Two more books to you that will save your bacon all the way through nursing school, starting now. The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current NANDA-I 2015-2017 nursing diagnoses and includes several that have been withdrawn for lack of evidence.

The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

Up Vote Up Vote ×

Hello!

I think if we follow ABC rule (Airway, Breathing and Circulation) then risk for bleeding will come first as it is related to impaired circulation. However it depends on what it is related to.

Up Vote Up Vote ×

This can often depend on the instructor and situation, so prioritization is tricky. What I think of between risk for bleeding and pain is this: what is going to kill them faster? Pain or bleeding? So even if they're not bleeding, I'd go with bleeding over pain. I recently passed NCLEX and the Hurst review always told us, pain never killed anyone lol the point was that while pain does need to be dealt with, I'd say bleeding is more important. Again, depends on instructor, many will still say to deal with the pain first. I'd deal with any risk for bleeding because post partum hemorrhage is NOT an easy fix all the time. Good luck and let us know how it goes!

Up Vote Up Vote ×
I have to do a care plan on my post partum patient who is pretty much healthy and normal.

I had to choose 4 diagnosis for my care plan the 4 i chose for my pt are

1. Risk for bleeding

2. Acute Pain

3. Impaired tissue integrity ( she had a c section)

4. ineffective Breast Feeding

Now i am having a difficult time with prioritizing them in the correct order because some say all "actual" nursing diagnoses have priority over any "risk for" diagnosis. But then i keep thinking and I feel like the "risk for bleeding" has priority over acute pain because my initial response would be to assess for hemorrhage or impending hypovolemia as well as preventing hemorrhage before taking care of the acute pain. I cant figure out the best way to sequence these diagnoses, please help.

Based on Maslow hierarchy of needs I would say that the prioritizing factor is acute pain, however you can see that all the diagnosis are actually a result of the impaired skin integrity. As she would not have pain, problems with feeding, or risk for bleeding if it wasn't because of the c-section.

Up Vote Up Vote ×
+ Join the Discussion