Need help prioritizing risk of diagnosis

turnforthenurse, MSN, NP · Feb 26, 2011

i would say risk for infection first, risk for impaired skin integrity (but once you have impaired skin integrity, you're at risk for infection!) and then constipation last. nurses are always concerned about infection and ways to prevent it! also consider the patient's history (if available). if they are immunocompromised, infection can definitely kill them! :twocents:

solneeshka, BSN, RN · Feb 27, 2011

If this is an actual care plan for an actual patient, then you will know the details of what's going on with the patient that prioritizes these risks. The list below doesn't give us enough info to tell you. For example, is it a new peg tube? If so, the risk for infection is high because you still have an open wound. Is it a peg tube the patient has had for 8 years and that doesn't currently show any signs of infection? If so, then the risk isn't so high. In regard to the constipation, is this patient also taking opioid analgesics? If yes, they have a higher risk of constipation than they do if they are not taking opioids. How decreased is their mobility? Is it just lower than normal because they're not feeling well, or is it the case that they just had a foot amputated and they really can't walk at all? In the first case, lower risk of constipation; in the second, higher risk of constipation. Same with skin integrity. Is the patient unusually overweight or underweight? If so, they have a higher skin integrity risk than they do if they are of a healthy size.

My point is that if you are trying to rank these risks in your care plan, none of them are objectively a higher risk than the others. The rank of the risk depends on your particular patient's situation, and when we say "prioritize" these risks, what we are actually saying is, "Which situation do you think is most likely to be a problem?" It's confusing because usually when we talk in nursing about prioritizing, we mean which is the biggest danger to the patient (airway breathing circulation, etc.). But in care plans, what we mean is "What is the thing that the patient is most likely to have to deal with," and I guess you don't want to completely neglect the potential acuity of the risk, but really it's the likelihood that it will happen that you're talking about.

For example, any patient who eats could potentially laugh while they're eating and then choke on their food. "Risk for aspiration r/t food inhalation, secondary to laughing while eating." This would be a very serious problem if it happened! Patient could be dead in minutes, and it's a risk that applies to almost every single patient in the entire hospital. Way bigger danger than skin integrity, infection, and constipation combined. But you would never see it on a care plan because the chances that it might happen are very, very, very slim.

I hope this is useful to you! I'm sure you've already turned this assignment in, but maybe this will be helpful on future assignments.