Nursing diagnosis, how do you prioritize

[dannygirl04]

I thought I read somewhere that you should prioritize your nursing diagnoses on a care according to how serious it was (life threat or not). Then after you list the actual problems you do the "risk for" diagnosis. So I'm doing a care plan on a patient who had bilateral total knee replacement. My 3 diagnoses are acute pain, risk for infection and anxiety. I have them listed in that order. Should I switch them so it's acute pain, anxiety, and then risk for infection?

[JustBeachyNurse, LPN]

It's a misconception that a risk for diagnosis is a lower priority than an actual problem. You prioritize based upon your patient assessment.

A risk for infection d/t 20cm open abdominal incision d/t open surgical repair of small intestine laceration resulting from traumatic impalement on a piece of rusty rebar would be a higher priority than anxiety.

[JustBeachyNurse, LPN]

What in your assessment leads to a nursing diagnosis of anxiety? Do you have a NANDA-I 2012-2014 book?

Why not impaired physical mobility or impaired walking or activity intolerance/risk for activity intolerance?

[dannygirl04]

I had to do one psych/social diagnosis. The patient was quite anxious about being in the hospital and stated several times that he was very anxious about the going through the surgery and the changes it would mean he would have to make even though he understood they would be short term.

[Esme12, ASN, BSN, RN]

right.... so which would be more important.....the RISK for infection or the anxiety he actually HAS?

A risk for diagnosis can take precedence at times if the risk is likely to happen. For instance.....a patient that has abnormal clotting times and low platelet count has a high risk for bleeding that is more important to their health than anxiety...see the difference?

For this patient while they have had surgery it isn't likely to get an infection....at least that is the hope. The anxiety he has.

[JustBeachyNurse, LPN]

Ok. Just make sure you use the NANDA-I criteria and related to factors to ensure that the diagnosis is appropriate for your assessment.

[PapaBearRN, BSN]

I prioritize beginning with the ABCs and using Maslow's heirarchy of needs.

[dannygirl04]

Esme 12 - That's how I ended up prioritizing them. I did acute pain, anxiety, and then risk for infection. I decided that that made the most sense since he had the anxiety, but based on the surgery he had and the knowledge he seemed to possess about how to take care of the surgical incision that he was less likely to develop the infection (hopefully). Now I just wait to see if my instructor agrees.

Thanks everyone for all of the help!

[Esme12, ASN, BSN, RN]

See you just critically thought about it! Good for you!

[nurseprnRN, BSN, RN]

Esme 12 - That's how I ended up prioritizing them. I did acute pain, anxiety, and then risk for infection. I decided that that made the most sense since he had the anxiety, but based on the surgery he had and the knowledge he seemed to possess about how to take care of the surgical incision that he was less likely to develop the infection (hopefully). Now I just wait to see if my instructor agrees.

Thanks everyone for all of the help!

Good thinking! We love to see this developing in students. It's also beneficial to other students to hear how you thought it out and defended your decision-- important things in a nurse.

:flwrhrts: dannygirl04 :flwrhrts: