Nursing priority question...

Columnist · Jun 7, 2012

Hello and welcome to the site. I moved your thread to Nursing Student Assistance where I think you will get more response.

Esme12, ASN, BSN, RN · Jun 7, 2012

i'm an lpn in an adn program.i'm doing a nursing case study. patient nursing dx i have come up with are impaired skin integrity, non-compliance, constipation, chronic pain, and impaired verbal communication (non-native tongue speaker). i've looked at maslow's hierarchy and researched them.
thoughts. sorry, if this doesn't make sense i've been beating my head against my desk.

hi! welcome to an........without knowing the case study itself it is impossible to tell what need to come first.

you are asking about priority of nursing interventions. i am going to tell you that in problem solving you need to remember that we use the nursing process as a tool to help us here. the nursing process is our problem solving tool, has 5 steps, one of which is nursing interventions. however, nursing interventions come at step #3. before you jump in to doing any interventions, you need to make sure you have a solid foundation for what you are going to do. get steps #1 and #2 clear in your mind first:

step #1 assess the situation
step #2 determine what the problem(s) is/are
step #3 plan care - you know what the major problem is. what, nurse, can you do about it that is within your scope of practice

the biggest thing about a care plan is the assessment, of the patient. the second is knowledge about the disease process. first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms.

the medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the medical diagnosis is what the patient has and the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. it is trying to teach you how to think like a nurse.

think of them as a recipe to caring for your patient. your plan of care.

every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the nanda taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what nanda calls defining characteristics.

here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

this link will take you to a thread about ndx: altered health maintenance which may help you. https://allnurses.com/nursing-student-assistance/ndx-altered-health-700426.html#post6393516

maslow's hierarchy of needs. the patients needs drive how important they are..... maslow's hierarchy of needs - enotes.com virginia henderson's need theory

maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization – e.g. morality, creativity, problem solving.
esteem – e.g. confidence, self-esteem, achievement, respect.
belongingness – e.g. love, friendship, intimacy, family.
safety – e.g. security of environment, employment, resources, health, property.
physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

maslow’s theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. abraham lincoln, thomas jefferson, albert einstein, eleanor roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.
another prioritization thread....https://allnurses.com/nursing-student-assistance/i-need-help-680570.html

minnymi · Jun 7, 2012

assuming i understand what you're saying....and i "think" i do...

i would say chronic pain would be #1 according the maslow.

a person has to have food, shelter, clothing before anything else....so if they are in pain they aren't going to want to do ANYTHING else. if their pain is relieved then they would be more likely/able to ambulate/comply which would also help with the constipation. i dunno....just my initial thought.

minnymi · Jun 7, 2012

are you saying the patient won't comply with taking pain medication? if that's the case, i would say impaired verbal communication would be the priority. maybe the patient isn't complying because they don't understand what you are trying to do to them. if you can communicate with them and get them to understand that you are giving them meds to relieve their pain then they might comply which will lead to ambulating....solving the constipation problem...etc. it's hard to give a good answer on an assignment i don't have....but those are my thoughts.

swflNurse · Jun 8, 2012

The information is very similar to this https://allnurses.com/nursing-student-assistance/scenario-nursing-care-498172.html scenario that was placed on Allnurses. Not a lot to go on. You made a great point about not wanting to do anything if they are in pain and also with the language barrier. I was also thinking depression could be setting in being that he is in a new place and is having such a hard time with communication, etc. Now I am starting to think about his skin integrity might be #1 being that it has non-blanchable redness and he refuses to leave his bed. WOW, A lot to think about. More information from the scenario I have would be helpful.

As a nurse though don't we have to be careful that we aren't making medical diagnoses?

kajh20 · Jun 8, 2012

Hi. I'm needing clairification, I'm not sure if i'm in the correct thread or not but I'm sure someone will move it if not. So, with a nursing diagnosis when asked for such on the NCLEX, would the correct answer be the one that is most related to the issue described? or does maslow's still apply and a nursing diagnosis that is a physiological one take priority? For instance, if a question stated a mental condition and wanted a nursing dx related to that, would that be the best answer option? or would it be the option with a nursing dx related to a physiological nursing diagnosis, like safety or something? I think I'm confusing myself more and more.

any help would be appreciated.

Thanks

minnymi · Jun 8, 2012

okay, the patient won't take the meds. now that that part is clear (lol), the priority is skin integrity. even if the patient won't walk, there are interventions to prevent further breakdown that can be done without ambulation. rotating ever two hours, etc.

next, work on the language barrier. once you can communicate with the patient, you can start talking about pain relief. if you can get the compliance issue solved by communicating then he will take the meds, be pain free, and more willing to ambulate. once he's ambulating and taking constipation meds...that problem is solved also.

you can't guarantee that he'll comply with the medication schedule or that he'll ever ambulate....but whether or not he EVER communicates with you, you have to prevent further skin breakdown. think of it as a real person in a ltc facility who spits out their medication and doesn't talk or move. what are you going to do? you're going to turn them and worry about their skin integrity #1 and work on the rest.

you are adding things to the issue that aren't there though. don't give yourself more work. it doesn't say anything about depression. although that might be an issue, it doesn't ask you to identify any other problems or potentials....so don't.

swflNurse · Jun 8, 2012

That's what I have down. Skin integrity, then the language barrier (which will help with compliance (meds) and hopefully mental well-being. Thank you for your help, Minny mi. You helped me start thinking straight! Even if I'm not right, I can make a good argument for my prioritization.

Esme12, ASN, BSN, RN · Jun 8, 2012

Application in Nursing

Maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.
another prioritization thread.....https://allnurses.com/nursing-student-assistance/ndx-altered-health-700426.html#post6393516

nurseprnRN, BSN, RN · Jun 8, 2012

as a brief clarification, the term "compliance" is no longer acceptable in this context and does not appear in most contemporary literature. "to comply" means to follow orders; this removes the concept of patient choice and make the patient the unacceptable one in the equation if he chooses not to follow them. the patient always has the choice to participate in the treatment plan someone else derives; it would be better if the patient were an active member of the team deriving the treatment plan, because this would increase the chances of success. this component of both nursing plans of care and medical plans of care is often forgotten.

but for now, when the team makes the plan and attempts to implement it, the patient makes the choice to adhere to it. then the question becomes, how do we foster patient adherence to the plan?, not, how do we make him follow our orders?

minnymi · Jun 8, 2012

That's what I have down. Skin integrity, then the language barrier (which will help with compliance (meds) and hopefully mental well-being. Thank you for your help, Minny mi. You helped me start thinking straight! Even if I'm not right, I can make a good argument for my prioritization.

no problem....i like to rattle my brain every now and then. sometimes you look at something so long and think about it so much....it takes someone from the outside looking in to get back to the basics.