Need help with prioritzing these Nur. Diag. for Nur. Pro. Paper please.

  1. Any help or comments would be great. I have to do a nursing process paper and we have to have 10 Nur Diag prioritized. Also, we have to do 5 Care Plans on the top 5. Any help would be great, and rationales as to why it should be 1,2,3,ect would be great as well. If any of them are basically the same thing let me know that as well. Thanks in advance!

    1. Pain
    --how would I write a diagnosis on pain for a lady who recently had hip surgery and has osteoarthritis pain??
    2. Knowledge deficit wiping

    3. Skin integrity

    4. Ineffective tissue perfusion

    4. Risk for falls

    5. Impaired physical mobility

    This is all I have so far, I'm struggling to think of five more!! But are these in the right order?

    Last edit by RNursingStudent on Mar 13, '07 : Reason: added question under PAIN
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  3. by   discobunni
    First off, do you have a good NANDA careplan book? It is a textbook requirement for my school and I use it A LOT! If you don't have one, get one... If you do it has everything all laid out for you already so open that book!! OK, for prioritizing DX I had ?'s about that too. They are going to tell you to prioritize by Maslows Heirarchy of Needs! Look at this thread, post #8 by Daytonite. The only thing that is iffy is Pain. My instructors prioritize pain right after ABC's, but Maslow's says differently. May want to check with your instructor first.
    Also, remember "RISK FORS" ALWAYS come AFTER any actual Nursing DX.
    Hope this helps.
  4. by   RNursingStudent
    Thanks. And I do have the NANDA ND book. I just don't know how to word the diagonosis for pain being that it is coming from two different sources. One being her arthritis and the other being from her surgery. Thanks again for you input. I think my brain is failing me with all this stuff! lol
  5. by   discobunni
    Good question. Seems like joint stiffness would be chronic pain and the surgical incision would be acute pain. I don't know if you should combine both DX or do one of each.....Hmph. I would think you would concentrate on just one DX.....especially the pain from her arthritis I think would be way down on the priority list (I think definately apply Maslow's for this one). Are all 10 DX for the SAME Patient? If they are, you probably have room for 2 pain DX, one for acute pain and one for chronic....I don't know though as I am a student too. I find a lot depends on the way your instructor looks at may quiz her about the 2-source question to do this assignment the way she wants so that you'll get a good grade....I've found what some instructors will count as right, others count as wrong. Ask her!!! (or him ;-)
  6. by   jade-athyst
    OK, let's see.... I graduated last year with a 3.8, so I should be able to do this.

    The pain would be 2 diagnoses: Acute pain R/T surical incision as manifested by........
    And Chronic pain R/T joint deterioration as manifested by...... (remember, you can never use an actual medical diagnosis (like arthritis) in a nursing diagnosis. )
    The order part has always been tricky for me, lets see...
    The first one would have to be 4, because that's the only ABC one, Circulation.
    Then the acute pain.
    Then the immobility, since it is really the root of the skin problems.
    Then skin integrity. The knowledge deficit "wiping" is a nursing diagnosis, but I'm wondering if it would fit better here as a D/T. You know, Skin integrity, impaired D/T knowledge deficit wiping, as manifested by excoriated skin......
    So that would give you four.
    You could put chronic pain either here or right after acute pain. This is where your nursing judgement comes in, (and your professor's preferences
    Risk for falls does have to go last, as it is not a "real" nursing diagnosis.
    I hope this helps, I could help you with the other five, if I knew the situation. Feel free to PM me and I'll give you contact info. if you need more help. ( I used to tutor the other students in my class, at the professor's reccomendation. To tell you the truth, I kind miss it!)
  7. by   RNursingStudent
    Thanks jade. I will definitely pm you if I can EVER think of any more diagnoses.
  8. by   NeosynephRN
    I am doing my preceptorship on an ortho maybe I can help a little...I think the order you have gotten so far is good... What about Activity intolerance r/t pain, surgical procedure.....Urinary retention r/t anesthesia, pain, fear.( we see that alot on my floor) Deficient Knoweldge r/t postoperative expectations and lifestyle changes, and a couple risk for's
    Risk for infection r/t invasive procedure. Risk for deficint fluid voulme r/t hypermetabolic state, fluid loss during surgery or presence of indwelling tubes. Just some that I have seen in my time on Ortho...which is not a huge amount...but maybe they would help!!
  9. by   Daytonite
    the correct sequencing of the nursing diagnoses you listed by priority (based on maslow's hierarchy of needs) is as follows:
    1. ineffective tissue perfusion (physiological need for oxygen)
    2. skin integrity (physiological need for nutrition)
    3. impaired physical mobility (physiological need for movement)
    4. pain (physiological need for comfort)
    5. knowledge deficit (self-actualization need for fact)
    6. risk for falls (anticipatory problem - safety need for protection)
    the choosing of nursing diagnoses is always based upon the abnormal data (signs and symptoms) that you found during the assessment phase of the nursing process. it is not necessarily based upon the medical diagnoses that the patient has. however, the signs and symptoms that describe a medical diagnosis can also be used to determine nursing diagnoses since these signs and symptoms are factual pieces of information. the determination of diagnosis, be it medical or nursing, is a decision that is based upon guidelines. the most common guidelines that nurses use in this process are the ones published by nanda-i. these guidelines (the definition of each nursing diagnosis, its related factors and defining characteristics) are widely repeated in a good many of the care plan and nursing diagnosis books in current publication. if you will also go to either of the following sticky threads on care plans, you will find links that i just posted the other day to the pages of the most commonly used nursing diagnoses on the gulanick/myers and ackley/ladwig care plan constructor sites if you do not have a current book. you will find each of your nursing diagnoses listed above between those two sites.
  10. by   RNursingStudent
    Thank you EVERYONE!!
  11. by   toriphile23
    what is knowledge deficit wiping? what does "wiping" mean?
  12. by   RNursingStudent
    toriphile23>> it would be hygiene, she didn't know how to wipe properly and it was causing her UTIs.