Please check my priority of RN Dx???

[AlaskaStudent]

Hello! Yes...another diagnoses priority question. Okay, so my patient has paraplegia of the lower extremities due to a spinal cord injury T12. The diagnoses I have chosen are as follows...this is also the order I have chosen for them. I am not sure where risk for infection should be in relation to the others. also whether urinary incontinence or constipation should come first...they seem to be on the same level of maslovs hierarchy?? Please let me know if these diagnoses are even written correctly. this is my first care plan and first stab at nursing diagnoses....

Constipation related to defective nerve stimulation and immobility as evidences by paraplegia of lower extremities.

Urinary incontinence related to impaired efferent pathway/spinal cord injury as evidenced by self straight catheterization 4 to 5 times a day and PRN.

Risk for infection related to invasive procedures/self straight catheterization.

Impaired physical mobility related to partial paralysis/spinal cord injury as evidenced by paraplegia of lower extremities.

Thanks so much! This forum is a life saver!!

[Daytonite, BSN, RN]

1. urinary incontinence related to impaired efferent pathway/spinal cord injury as evidenced by self straight catheterization 4 to 5 times a day and prn.
   
   • you evidence is incorrect. "straight catheterization 4 to 5 times a day and prn" is a treatment being performed for this medical problem, but tells us nothing about the urinary incontinence. if the patient did not catheterize, what would happen? would they wet? become distended? those are the symptoms that you need to list as the aeb information, or evidence, that prove the existence of this problem.
     

[*]constipation related to defective nerve stimulation and immobility as evidenced by paraplegia of lower extremities.

• again, your evidence of the problem (constipation) is incorrect. "paraplegia of lower extremities"is not evidence of constipation. it is a medical diagnosis of something else going on with the patient. constipation is when someone hasn't had a bm in several days, has dry and hard stools, or is unable to have a bm. there is a whole list of symptoms for this diagnosis listed in the taxonomy for this diagnosis.
  

[*]impaired physical mobility related to partial paralysis/spinal cord injury as evidenced by paraplegia of lower extremities.

[*]risk for infection related to invasive procedures/self straight catheterization.

• "risk for" diagnoses are always sequenced last because they are problems that do not yet exist and are never as important as the actual nursing problems that are sequenced above them.
  

- - - - - - - - - - - - - - -

the construction of the 3-part diagnostic statement follows this format:

p (problem) - e (etiology) - s (symptoms)

• problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information.
  
• etiology - also called the related factor by nanda, this is what is causing the problem. pathophysiologies need to be examined to find these etiologies. it is considered unprofessional to list a medical diagnosis, so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this.
  
• symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they can also be the same signs and symptoms of the medical disease the patient has, the patient's responses to their disease, and problems accomplishing their adls. they are evidence that prove the existence of the nursing problem. if you are unsure that a symptom belongs with a nursing problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.
  

[AlaskaStudent]

Thank you so much for your response. Believe it or not...those are the exact verbatim Dx my clinical instructor gave me...I thought they seemed off. I am sure my OTHER instructor would lose it if she saw them though. Here's the revised RN Diagnoses I came up with. I was thinking I would prioritize the constipation first as the patient verbalized that constipation is her number one concern and cheif medical complaint. any thoughts?

Constipation related to defective nerve stimulation and immobility as evidenced by difficult passage of dry, hard stools.

Reflex urinary incontinence related to impaired efferent pathway/spinal cord injury as evidenced patient verbalizing they have no sensation of urge to void.

Impaired physical mobility related to partial paralysis/spinal cord injury as evidenced by inability to move the lower extremities.

Risk for infection related to invasive procedures/self straight catheterization.

[Daytonite, BSN, RN]

They seem OK now. How many days between BMs for this patient? I would include that with the AEB evidence. A lot of times paraplegics may only have a BM every 3 or 4 days. That is definitely part of their constipation problem.