Need help with Priority Nursing Dx

I need help with the top 3 priority nursing dx! I kow it's ABC, but if the patient has no problem with those, what comes next? Help! This is what I have:

1. Acute pain r/t SBO amb verbal report of pain, guarding behavior, facial mask, and expressive behavior.
   
2. Imbalanced nutrition: less than body requirements r/t inability to digest food, increased metabolic demands, amb abdominal pain, body weight 20% under ideal
   
3. Disturbed sleep pattern r/t anxiety amb verbal reports of not feeling rested and being dissatisfied with sleep.
   
4. Nausea r/t SBO and pain amb verbal report of nausea.
   
5. Anxiety r/t physiological factors (SBO), stress, and change in health status amb expressing concern and worry about current health status, fear of requiring another surgery, sleep disturbance, and decreased BP and pulse.
   
6. Risk for infection r/t inadequate secondary defenses, pharmaceutical agents, and insufficient knowledge to avoid exposure to pathogens
   
7. Risk for falls r/t presense of acute illness, anemia, impaired balance and medications
   
8. Risk for injury r/t abnormal blood profile and chemical agents (alcohol consumption)
   

Thanks!

Five Levels of the Hierarchy of Needs

There are five different levels in Maslow’s hierarchy of needs:

1. Physiological Needs
   These include the most basic needs that are vital to survival, such as the need for water, air, food, and sleep. Maslow believed that these needs are the most basic and instinctive needs in the hierarchy because all needs become secondary until these physiological needs are met.
   
2. Security Needs
   These include needs for safety and security. Security needs are important for survival, but they are not as demanding as the physiological needs. Examples of security needs include a desire for steady employment, health insurance, safe neighborhoods, and shelter from the environment.
   
3. Social Needs
   These include needs for belonging, love, and affection. Maslow considered these needs to be less basic than physiological and security needs. Relationships such as friendships, romantic attachments, and families help fulfill this need for companionship and acceptance, as does involvement in social, community, or religious groups.
   
4. Esteem Needs
   After the first three needs have been satisfied, esteem needs becomes increasingly important. These include the need for things that reflect on self-esteem, personal worth, social recognition, and accomplishment.
   
5. Self-actualizing Needs
   This is the highest level of Maslow’s hierarchy of needs. Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others, and interested fulfilling their potential.
   

Care plans are all about your patient assessment....there is a glaring assessment that you need to address......Why is the patients B/P low? Why is the HR low? Qualify "low".

Anxiety r/t physiological factors (SBO), stress, and change in health status amb expressing concern and worry about current health status, fear of requiring another surgery, sleep disturbance, and decreased BP and pulse.

YOu have sufficient evidence for ineffective tissue perfusion....as you stated the patient had anemia. Qualify anemia.

NANDA lists contributing factors/evidence as

Common Related Factors

Impaired transport of oxygen

Interruption in blood flow

Mismatch of ventilation with blood flow

Decreased hemoglobin concentration in blood

Hypoventilation

Hypovolemia

Hypervolemia

Exchange problems

Altered affinity of hemoglobin for oxygen

Without your assessment and information it is really hard to say which is the more important nursing diagnosis.. How low is the B/P and how low does it go?

:) I agree...:)