Need help with priority diagnoses

proofof · Apr 1, 2012

What about pain?

Clovery · Apr 1, 2012

What about pain?

I didn't think it made the top three, but like I said, I'm stuck. My instructor even said "he just likes to take pain meds".

Do you think pain would come before or after diarrhea? What about impaired skin integrity?

working on my interventions for diarrhea now, not sure where to go next

psu_213, BSN, RN · Apr 1, 2012

I didn't think it made the top three, but like I said, I'm stuck. My instructor even said "he just likes to take pain meds".
Do you think pain would come before or after diarrhea? What about impaired skin integrity?
working on my interventions for diarrhea now, not sure where to go next

I think it is very poor practice to dismiss his pain by merely saying "he likes his pain meds." Just because he likes his meds does not mean that his pain is not real...or perhaps he would rather be pain free without meds than with them.

Clovery · Apr 1, 2012

I think it is very poor practice to dismiss his pain by merely saying "he likes his pain meds." Just because he likes his meds does not mean that his pain is not real...or perhaps he would rather be pain free without meds than with them.

I agree. I often get angry (on the inside) when I go to tell my instructor or the nurse that my patient is requesting their PRN pain meds and they roll their eyes.

He had a lap. gall bladder removal over a month ago, so he really shouldn't be in that much pain. But I just did a bit of research on it and found a condition called PCS so maybe I will include the pain dx and work in monitoring for that if I can find any nursing journal articles on it.

Do you think pain is more important than the skin integrity?

Thanks for your input, please keep the comments coming

sccm21988 · Apr 1, 2012

Go to NANDA nursing diagnosis book, how about bowel obstruction, pancreatitis, or even an impaction where runny stool comes around the impaction making it appear to be diarrhea

Clovery · Apr 1, 2012

Go to NANDA nursing diagnosis book, how about bowel obstruction, pancreatitis, or even an impaction where runny stool comes around the impaction making it appear to be diarrhea

what? I have several nursing dx books open on my desk right now... the patient had a positive stool sample for C. diff. which is causing diarrhea. Nurses can't diagnose any of those things you just listed :confused:

anyway, thanks for the reply.

I think I'm going to go with Diarrhea, Pain, and Impaired Skin Integrity. I'd like to address a whole slew of other issues with this patient but I'm trying to focus on what a nurse on a med-surg floor can accomplish, so that's how I'm prioritizing. Someone stop me if you think this is wrong.... I might be putting entirely too much thought into this :uhoh3:

Esme12, ASN, BSN, RN · Apr 1, 2012

The diarrhea is due to the infectious process from the C-diff. The diarrhea can cause a break in skin integrity from frequent stooling and his obesity. PCS is real Medscape: Medscape Access (you need to register but it free, no catches) and is difficult to diagnose especially when medical professionals become dismissive of the patient is: he likes his pain meds. Diarrhea can cause dehydration, malnutrition and mimic malabsorption like syndromes

"The term postcholecystectomy syndrome (PCS) describes the presence of symptoms after cholecystectomy.These symptoms can represent either the continuation of symptoms thought to be caused by the gallbladder or the development of new symptoms normally attributed to the gallbladder. PCS also includes the development of symptoms caused by removal of the gallbladder.

In general, PCS is a preliminary diagnosis and should be renamed relevant to the disease identified by an adequate workup. PCS is caused by alterations in bile flow due to the loss of the reservoir function of the gallbladder. Two types of problems may arise. The first problem is continuously increased bile flow into the upper GI tract, which may contribute to esophagitis and gastritis. The second consequence is related to the lower GI tract, where diarrhea and colicky lower abdominal pain may result."

Damage to the bile duct is also difficult to diagnose and is a real issue Diagnosis and treatment of bile duct strictures after laparoscopic cholecystectomy.

For priority think maslow's.

nurseprnRN, BSN, RN · Apr 2, 2012

i agree, i'd take pain above the imbalanced nutrition because it's worse for him now than his nutritional probs. if he gets worked up for pcs and it's diagnosed, that will knock nutrition right down to the bottom of the list, while they take care of his inflammation and pain. poor guy.

and the nurses on the floor and your instructor might appreciate the printout on pcs, too. and i'd leave one in his chart, just because the copy machine was working so well already.

OCNRN63, RN · Apr 2, 2012

I didn't think it made the top three, but like I said, I'm stuck. My instructor even said "he just likes to take pain meds".
Do you think pain would come before or after diarrhea? What about impaired skin integrity?
working on my interventions for diarrhea now, not sure where to go next

Your instructor needs a whack upside the head for that comment. It shows a staggering indifference/ lack of education regarding pain management.

SHGR, MSN, RN, CNS · Apr 2, 2012

Impaired physical mobility? That is the first thing I saw there. The skin integrity, pain, depression, and difficulty with ADL's all relate to that.

And yes, that is a very ignorant attitude about pain.

When I was in school and a new nurse, we had the mantra, "Pain is whatever the patient says it is, occurring whenever and wherever the patient says it does." Has the pendulum swung 180?

trauma_lama, BSN · Apr 2, 2012

i'm just a student but it seems like risk for infection r/t ulcers might be important since it could be so catastrophic if a severe infection occured...?