Priority Order of nursing Nursing Diagnosis..

  1. Hello there..
    I need help on my lst concept mapping on skin assessment..
    My pt has hx. DVT/anemia/Lupus/Diabetes/Gastric Ulcer/HTN
    He just got surgery done to remove his blood clots on his lower extremity.

    Here is my nursing diagnosis according most important-least
    1. Risk for infection.. r/t surgical incision/-diabete/anticoagulant durgs....
    2. impaired skin integrity
    3. Depression..

    Do I have orders right? Any suggestion is appreciated. Thanks a lot!!
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    About nervefreak

    Joined: Dec '04; Posts: 30


  3. by   AuntieRN
    The way we were taught to prioritize them were ABC's first then safety..etc...Now I just graduated so perhaps some of the more seasoned nurses have a better suggestion but...I would probably have picked something like:
    risk for fluid volume defecit r/t low RBC (can't use anemia as it is a diagnosis so you have to use something that refers to it.)
    acute pain r/t incision
    risk for infection r/t incision
    impaired skin integrity r/t incision, bedrest

    Hope this helps. Writing careplans was not my strong point. I know what to do and how to take care of my pts, but for the life of me can not seem to put it under NANDA and write it on paper in a plan form. Good luck to you!!
  4. by   nervefreak
    Thanks for reply.... Sorry, but what is ABC? Airway breathe Cardiac???
    Also the pt is on 1.2 L fluid set and 1800 Cal Diet.

    We were told to pick out 2 physiologic, (one should related to skin)1. psychosocial..
    Use skin one for Concept Mapping..Care plan has taken me soo many days and I'm still working on it..
  5. by   augigi
    I was always taught to do physical needs first, then psychosocial needs. Actual needs first, then risks.

    There are lots he could have:
    - Risk unstable blood sugars
    - Risk impaired skin integrity r/t immobility, chronic disease, diabetes, nutritional deficits
    - Infection r/t surgical incision, diabetes, nutritional deficits, immobility (don't think anticoagulant leads to infection)
    - Risk bleeding (anticoagulant therapy, surgical incision)

    etc etc
  6. by   Daytonite
    first off, you've got a problem with one of your diagnoses. there is no nanda diagnosis for depression. you will have to look at the symptoms the patient is having for the depression and use those to find other nursing diagnoses to address problems (s)he is having relating to the depression.

    secondly, any diagnosis starting with the words, "risk of" is what is called an anticipatory problem and does not yet exist. so, in the hierarchy of priorities it is listed last.

    therefore, based on what you have listed and removing the nonexistent diagnosis, the order should be:
    1. impaired skin integrity
    2. risk for infection
    here are some links to information already on the allnurses forums to help you with prioritizing your diagnosis lists as well as how to chose a nursing diagnoses. i am also including a link to a listing nanda diagnoses. - sequencing and prioritizing of nursing diagnoses on written care plans - nursing diagnosis troubles - a complete list of nanda nursing diagnoses organized by gordon's functional patterns

    please read over the information in these forum threads on care planning:
    if you are still having further problems with this assignment, ask and i will help you.
  7. by   nervefreak

    Much appreciated. Thanks for those links and they really did great help on my confusion about care plan and RNSG dx.

    My final RNSG Dx..

    1, acute pain r/t incision, surgery
    2. impaired skin integrity
    3. infeective role performance

    Does it make moare sense now??
  8. by   Daytonite
    I would change the order to:
    1. Impaired Skin Integrity
    2. Acute Pain R/T surgical intervention
    3. Ineffective Role Performance
    Under both Maslow and Gordon, this is the sequence these nursing diagnoses would be listed in priority.

    You don't list your "related to" items or "defining characteristics" for the Impaired Skin Integrity or the Ineffective Role Performance. You have determined these elements already, haven't you?
  9. by   nervefreak
    Yes, I have listed r/t and AED on my paper. Thanks again, Daytonite. Once I'm done with my lst paper (clock is kicking... ), I'm gonna go through all the links you gave me AGAIN. If anything confuses me again, I will ask you for sure. !!!!
  10. by   augigi
    That order is because pain is considered a "psychosocial" need and not a physical need.
  11. by   Daytonite
    Pain is listed second below Impaired Skin Integrity because under Maslow's Hierarchy of Needs the physiological need for nourishment of the skin and tissues (in order to heal) comes above satisfying pain which is an issue of comfort. Under Gordon's 11 Functional Patterns Impaired Skin Integrity comes under the Nutritional-Metabilic Functional Health Pattern (#2 out of the 11), whereas Acute Pain comes under Cognitive-Perceptual (#6 out of the 11). Ineffective Role Performance is a self-esteem need under Maslow which is on the second tier of the pyramid on his hierarchy. That is the rationale behind the way I sequenced them.
  12. by   Megsd
    In Gordon's 11 paterns, are they really ranked in priority order? I never thought about it. I always have difficulty prioritizing my nursing diagnoses... that would really help to have that to follow (it's a little more detailed than Maslow).
  13. by   Daytonite
    Quote from megsd
    in gordon's 11 paterns, are they really ranked in priority order? i never thought about it. i always have difficulty prioritizing my nursing diagnoses... that would really help to have that to follow (it's a little more detailed than maslow).
    use maslow. he clearly delineates the order of needs within each tier of his pyramid. the problem with using gordon's is that you have to determine the priority of the diagnoses you use within each of the 11 categories. with maslow, there is no room for doubt. he clearly establishes your priorities. if you need a listing of maslow's hierarchy you can access it here:'s_hierarchy_of_needs they are also listed in nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig on page 1325 with lists of the nursing diagnoses that fit under each of the major pyramid divisions in the pages that follow.