nursing dx

[tetrs04]

so im doing my care plan and i need 10 priority nursing dx for my pt. i think i got it but i wanted some opinions.

pt stats- 90 yo

female

admit for L hip fx

surgery for hip fx was on dec 26 2009

pt still in hospital as of 05-05-10

while having the surgery she suffered MI and embolic cva

pt on hemodialysis, has AV graft in upper arm

ECG was abnormal- sinus tachycardia, left axis deviation, inferior infarct, anterolateral infarct

Labs-low RBC,Hgb, Hct, MCHC

high RDW

Anion gap is 5-low

Na and Cl are both high

CO2 is low

Ca and Mg are both low

Creatinine is high

Hx includes- chronic anemia due to renal insufficiency, HTN, Permanent Pacemaker, Coronary stents, Thyroid disease

vitals- pulse 68, resp 16, BP 152/76

Nursing Dx

1.Impaired swallowing R/T neuromuscular dysfunction AEB puree diet ordered for patients dysphagia

2.Activity intolerance R/T imbalance between oxygen supply and demand AEB dyspnea upon exertion

3.Fatigue R/T decreased oxygen supply to the body AEB decreased lab values of RBC, Hct, Hgb, MCHC

4.Decreased cardiac output R/T dysrhythmias AEB ECG results of sinus tachycardia, left axis deviation, inferior and anterolateral infarct.

5.Ineffective tissue perfusion, peripheral R/T interrupted blood flow AEB peripheral edema, diminished pedal pulses

6.Impaired skin integrity R/T limited mobility AEB sacral decubitus ulcer

7.Acute pain R/T left hip fracture AEB limited ability to support full body weight on left side and facial grimacing

8.Excess fluid volume R/T renal insufficiency AEB minimal urine output

9. Impaired physical mobility R/T surgical procedure, L hip O.R.I.F. AEB limited weight bearing ability

10.Impaired verbal communication R/T decrease in circulation to brain AEB aphasia

Risk for Aspiration: Risk Factors- s/p embolic stroke, difficulty swallowing

Risk for Deficient Fluid Volume: Risk Factors- excessive removal of fluid during dialysis

thanx

-sam

[JSlice., ASN, RN]

So, are your diagnoses ordered according to the top priority? Which side of the body did the stroke affect? She was admitted for the Hipfx, but since she suffered a stroke during sx, I would place something regarding inadequate perfusion because of the MI and CVA as priority.

[RNTutor, BSN, RN]

First off, I agree with JSlice...if the dx need to be in order of priority, they need to be rearranged a bit. Remember the ABC's...Airway, Breathing, Circulation!

1.Impaired swallowing R/T neuromuscular dysfunction AEB puree diet ordered for patients dysphagia

Be careful with this AEB, it is not actually an assessment, but the puree diet is an intervention. What did you see (either in person, or via her chart) that indicated that she was having difficulty swallowing? Did she fail a swallow test, did she choke when drinking some water? I think that would be better evidence.

[tetrs04]

thnx for the help. ur right i need to change the AEB for the impaired swallowing. so wer all in agreement that the dx need to be rearranged. my problem is that im not sure how to rearrange them. kinda thought they already were in priority order. but apparently not lol any help with that??

-sam

[RNTutor, BSN, RN]

The way I always think about it is, if I could only address 1 nursing dx today, which one would it be? And then I answer it by picking that one that would have the most serious adverse effect if left unaddressed (aka...death!). And I use the ABCs to help decide.

None of you dx seem to deal directly with Airway or Breathing...but what about Circulation? Those are the nursing dx that should be first. Then keep putting them in order based on Maslow, with physical needs on up.