Priority diagnoses for care plan

[superdave]

I'm trying to figure out the priority nursing diagnoses for my Pt( at least 1 psych and 1 educational). Admitting diagnoses of cellulitis, SOB, and chest pain. Hx of severe anxiety, depresion, immunosupression, anema, and COPD.

Here is what I've come up with

Impaired gas exchange R/T obstructed lung disease aeb difficulty breathing during minor activity.

Impaired tissue integrity R/T bacteria infection aeb swelling, redness, and tenderness in extremity.

Acute pain R/T tissue damage 2° to cellulitis aeb Pt states very painful to move affected extremity

Anxiety R/T change in health status aeb Pt stating "I'm very nervous about my condition".

Activity intolerance R/T imbalance between oxygen supply and demand aeb pt reports being SOB moving around in bed or ambulating 10 feet.

Deficient knowledge R/T health risks of smoking aeb Pt currently a ½ -1 pack a day smoker.

Thank you for any help you can provide.

[Daytonite, BSN, RN]

hi, superdave, and welcome to allnurses! :welcome:

i use maslow as a guide for prioritizing:

1. impaired gas exchange (physiological need for oxygen)
   
2. activity intolerance (physiological need for oxygen)
   
3. impaired tissue integrity (physiological need for nutrients and oxygen)
   
4. acute pain (physiological need for comfort) [be aware that some instructors want to place this in a top priority over others]
   
5. anxiety (security need)
   
6. deficient knowledge (safety need)

however! i see a few problems with the construction of your nursing diagnoses! did you use a nursing diagnosis reference when you were putting these diagnostic statement together? you need to in order to make sure you are getting your related factors (etiologies) correct for those diagnoses.

impaired gas exchange r/t obstructed lung disease aeb difficulty breathing during minor activity.

there are only two related factors that go with this diagnosis:

• alveolar-capillary membrane changes
  
• ventilation perfusion imbalance

you need to know what each of these are and which one applies to your patient's situation. you need to know the pathophysiology of copd to understand which one is the most likely cause of this patient's oxygen deficit problem. one of these will be your r/t item not "obstructed lung disease" although you can say impaired gas exchange r/t ___ secondary to obstructed lung disease aeb xxx. now, "difficulty breathing during minor activity" sounds a lot like activity intolerance to me. the defining characteristics (symptoms) of impaired gas exchange are (page 94, nanda-i nursing diagnoses: definitions & classification 2007-2008):

• abnormal arterial blood gasses
  
• abnormal arterial ph
  
• abnormal breathing (e.g. rate, rhythm, depth)
  
• confusion
  
• cyanosis (in neonates only)
  
• decreased carbon dioxide
  
• diaphoresis
  
• dyspnea
  
• headache upon awakening
  
• hypercapnia
  
• hypercarbia
  
• hypoxemia
  
• hypoxia
  
• irritability
  
• nasal flaring
  
• restlessness
  
• somnolence
  
• tachycardia
  
• visual disturbances

do you have a set of abgs for this patient? that would be better supportive evidence of impaired gas exchange. here are links to webpages on this particular diagnosis: [color=#3366ff]impaired gas exchange http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=23

acute pain r/t tissue damage 2° to cellulitis aeb pt states very painful to move affected extremity

i'm not sure that the patient's pain in their leg is because of the tissue damage. what causes pain? pain receptors in the area must be stimulated. what stimulates them? primarily swelling and inflammation of the involved tissues. therefore, this diagnostic statement should look something like acute pain r/t swelling and inflammation secondary to cellulitis aeb patient's statement of a level of pain of 8 on a scale of 10 and patient's verbalization of pain with movement of the affected extremity. you need to describe the patient's symptoms of their pain. here are links to webpages on this particular diagnosis: [color=#3366ff]acute pain http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=40

anxiety r/t change in health status aeb pt stating "i'm very nervous about my condition"

can you make that patient's statement a little more specific. what specifically is he/she so nervous about? losing their leg? never walking normally again? the leg ending up looking weird after it heals?

deficient knowledge r/t health risks of smoking aeb pt currently a ½ -1 pack a day smoker.

you have to specify the knowledge deficit in the title of the nursing diagnosis. in this case it would be "smoking" or "smoking cessation". your related factor has to be why (the etiology) he/she doesn't have this information. "health risks of smoking" is not why the patient hasn't stopped smoking. this knowledge deficit is going to be due to (page 130, nanda-i nursing diagnoses: definitions & classification 2007-2008):

• cognitive limitation
  
• information misinterpretation
  
• lack of exposure
  
• lack of interest in learning [the most likely reason--the symptom of this is apathy]
  
• lack of recall
  
• unfamiliarity with information resources [another possibility]

the symptoms (aeb items) for this will not be that the patient is currently a ½ -1 pack a day smoker. that does not describe the problem of knowledge deficit. he can verbalize that he knows that smoking ½ -1 pack a day is a problem and that he has been unable to follow through with instructions on how to stop smoking. so, keep your symptoms geared toward, and supporting of, the underlying etiology of the problem. here are links to webpages on this particular diagnosis: [color=#3366ff]deficient knowledge (specify) http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=34

carry on!