order of priority of nursing diagnoses!

[michelleped]

I need help deciding the order of priority of these 3 nursing diagnoses for my care plan (and if I chose good diagnoses!)....

Ineffective airway clearance, Ineffective peripheral tissue perfusion, Risk for shock

(its for a patient who has sepsis, hypotention, dehydration, dyspnea, edema, rhonchi, tachypnea, and who is obese, age65)

[Esme12, ASN, BSN, RN]

you prioritize your needs according to maslow's hierarchy of needs.

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. least important
  
• 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. most important
  

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.
  

the bottom of the pyramid being the most important and the top being the least important in the matter of survival. so, looking at your diagnosis.....which will be the most important to full fill first. the actual diagnosis then the risk of diagnosis? right? which is then the most important.......remember abc's....airway breathing circulation, first. right?

i hope this helps.

[emtb2rn, BSN, RN, EMT-B]

What Esme says. Think about it this way, what's going to kill 'em and in what order?

[psu_213, BSN, RN]

The other thing to remember...it is almost impossible to find a nursing dxs. when given only medical diagnoses. While the medical dx can point you in the right direction, the nursing diagnoses have to be based on assessment. Then prioritize them based on what you need to treat first.

[BostonFNP, APRN]

Always think ABC first!

[KimberlyRN89, BSN, RN]

Ditto to what everyone else has said lol. In class we were taught the things we could see go first (order them by ABC, Maslow's) and then the "risk for" are last.

[nurseprnRN, BSN, RN]

medical diagnoses are derived from medical assessments-- diagnostic imaging, laboratory studies, pathology analyses, and the like. this is not to say that nursing diagnosis doesn't use the same information, so read on.

nursing diagnoses are derived from nursing assessments, not medical ones. so to make a nursing diagnosis, a nursing assessment has to occur. for that, well, you need to either examine the patient yourself, or (if you're planning care ahead of time before you've seen the patient) find out about the usual presentation and usual nursing care for a given patient.

medical diagnoses, when accurate, can be supporting documentation for a nursing diagnosis, for example, "activity intolerance related to (because the patient has) congestive heart failure/duchenne's muscular dystrophy/chronic pulmonary insufficiency/amputation with leg prosthesis." however, your faculty will then ask you how you know. this is the dread (and often misunderstood) "as evidenced by."

in the case of activity intolerance, how have you been able to make that diagnosis? you will likely have observed something like, "chest pain during physical activity/inability to walk >25 feet due to fatigue/inability to complete am care without frequent rest periods/shortness of breath at rest with desaturation to spo2 85% with turning in bed."

so, you don't think of a diagnosis for your patient and then go searching for supporting data. you collect data and then figure out a nursing diagnosis.

i hope this is helpful to you who are just starting out in this wonderful profession. it's got a great body of knowledge waiting out there to help you do well for and by your patients, and you do need to understand its processes.