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nursing diagnoses

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by guest1134757 guest1134757 (Member)

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what is a higher priority diagnosis.....

Pain related to surgical incision site secondary to cesarean section

ineffective breastfeeding related to difficulty of neonate to attach and suck secondary to flat nipples and poor infant sucking reflex

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Rose_Queen is a BSN, MSN, RN and specializes in OR, education.

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Priority depends on the individual patient. There is no set way that states which nursing diagnosis takes priority. Go back to your patient assessment and determine what, for this particular patient, needs to be the priority.

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What are your thoughts and rationales specific to your patient?

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Pain.  Pain is so significant, that some call it "The sixth vital sign".  Given that pain interferes with all other functions, it is the clear priority.

 

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Just now, hherrn said:

Pain.  Pain is so significant, that some call it "The sixth vital sign".  Given that pain interferes with all other functions, it is the clear priority.

 

I disagree.  Ineffective breastfeeding is clearly the priority for two reasons-

1- The patient's perception of her value as a mother, and therefore as a human being, is at risk resulting from  her inabilty to meet the needs of her newborn.

2- This problem actually involves two patients, as it effects the infant's well being.

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Hmmm ok I had went with pain but maybe I need to change it then. We have to do a patho on the priority problem so I really don’t want to choose the wrong one but I can see it both ways. Ugh

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In all seriousness, this can be seen from either direction, and probably justified either way.  As you have probably learned by now, most nurses don't put huge stock in nursing diagnoses, and once out of school, are not very good at it.

 

 

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15 minutes ago, hherrn said:

Pain.  Pain is so significant, that some call it "The sixth vital sign".  Given that pain interferes with all other functions, it is the clear priority.

 

Very possibly the textbook answer they want. However, I don't think it's clearly the priority every time some degree of it exists. Pain is still a valid nursing dx even if it is mild such that the patient requires minimal intervention for it. In that case it may be quite low priority according to a patient set on breastfeeding.

Pain affects everything else, but significant emotional distress affects pain perception and tolerance itself. (We do not know how distressing the breastfeeding issue is to this mother, either, which is why all around more information is required).

Since we aren't given more information, it might be best to go with pain. In reality I would feel more comfortable with that if it were something like breast/nipple pain (which would also be directly affecting the breastfeeding process).

Edited by JKL33

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9 hours ago, JKL33 said:

Very possibly the textbook answer they want. However, I don't think it's clearly the priority every time some degree of it exists. Pain is still a valid nursing dx even if it is mild such that the patient requires minimal intervention for it. In that case it may be quite low priority according to a patient set on breastfeeding.

Pain affects everything else, but significant emotional distress affects pain perception and tolerance itself. (We do not know how distressing the breastfeeding issue is to this mother, either, which is why all around more information is required).

Since we aren't given more information, it might be best to go with pain. In reality I would feel more comfortable with that if it were something like breast/nipple pain (which would also be directly affecting the breastfeeding process).

I agree.  That's why I went with ineffective breastfeeding.

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_Cecilia_ is a BSN, RN and specializes in Pediatrics.

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On 12/7/2019 at 10:10 AM, guest1134757 said:

what is a higher priority diagnosis.....

Pain related to surgical incision site secondary to cesarean section

ineffective breastfeeding related to difficulty of neonate to attach and suck secondary to flat nipples and poor infant sucking reflex

From what I remember, to determine priority, I would first utilize Maslow's Hierarchy of Needs. Maslow's Hierarchy goes as follows from the Highest Priority to Lowest Priority: Physiological Needs (Air, water, food, shelter, clothing, reproduction), Safety (Resources, health, personal security), Love and Belonging, Esteem, and Self-Actualization.

Seeing that both are related to Physiological Needs, I would now want to determine causes/results of each diagnosis (focus on Pathology, considering you are asked for Patho priority).

I'm thinking...

1. Pain at the surgical incision site could be because of infection or bleeding, or it simply could be mild pain because of the c-section. This depends on how recent the c-section was. 

2. Ineffective breastfeeding techniques would lead to imbalanced nutrition: less than body requirements for the neonate, and if not intervened, could lead to failure to thrive r/t lack of nutrition. But I feel this is more towards results, rather than what's causing "flat nipples" and "poor infant sucking reflex." For me, flat nipples and a poor infant sucking reflex are clear causes. 

Pain, on the other hand, can be caused by different things (as I mentioned earlier).... so based on my rationale, I would follow pain because of the possibility of bleeding/infection as causes of pain (ABC's). 

 

Of course in real life, you'd definitely want to assess all other aspects. Ex: when was the c-section, SLIDTA (Severity, location, Influencing factors, duration, type, associating symptoms) for pain, VS to rule out infection/bleeding, etc.

I'd love to know what your class determined as the answer, and what the rationale was.

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I know this is old so it probably doesn't matter now 😂 But, as _Cecilia_ said, I'd love to know what happened when you turned it in - What did you go with, what did your instructor say? 

I think what would have a lot to do with it is what the AEB are. I'm not sure about your school, but when I was in school we had to give AEB. So, I think the priority would be determined by the patient's signs and symptoms (AEB). What was your patient exhibiting that lead you to the diagnoses, given the signs and symptoms, you might be able to determine which takes priority in this case. If the patient's signs and symptoms related to her pain are the usual S&S after a C-section, and not what could lead you to believe the patient might be developing an infection or bleeding, etc., then the other diagnosis might be priority. If the ineffective breastfeeding is leading to signs the baby is not getting enough to eat or it is hitting the mother hard mentally/emotionally, then that might take priority. So, to me, I would base it on what signs and symptoms to determine priority, the ones I used in the AEB, that lead me to the diagnosis in the first place.

But again, I'm just curious what you went with and what your instructor thought of it! 🤔

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