please help me prioritize ND

LadyK,RN · Mar 12, 2009

Check Tabers encyclopedia and your text for some basic NANDA diagnoses r/t chronic pancreatitis. I'm sure if you post some of your ideas and your rationales, the more experienced folks on this site will help you prioritize them and/or add a few.

LadyK,RN · Mar 12, 2009

Also see Daytonites reply under Nsg Dx for Total Hip Replacement. It is a very comprehensive response to developing nsg dx.

Daytonite, BSN, RN · Mar 12, 2009

your thread is entitled "please help me prioritize nd". i can do that, but where is your list of nursing diagnoses?

do you still have to do a care plan for this patient even through you didn't care for the patient? start by researching the pathophysiology, signs and symptoms and complications of chronic pancreatitis. you can see how a care plan is constructed on this thread: https://allnurses.com/general-nursing-student/help-care-plans-286986.html - help with care plans. if you still need help after you have done this preliminary work, post a list of the signs and symptoms you have developed and i will help you.

nursing diagnoses are usually prioritized by maslow's hierarchy of needs: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

tbell2 · Mar 12, 2009

Your thread is entitled "please help me prioritize ND". I can do that, but where is your list of nursing diagnoses?

Sorry, I was trying to get my 4 year old out to preschool and one year old twins down for a nap so I could have complete quiet while working. So much easier now. I wasn't asking anyone else to do my work for me.

I will care for this pt tomorrow. I did most of my research last night and have come up with several ND, but I want to make sure I prioritize because my instructor said I could have done that better with my pt a couple weeks ago. Here is what I have, without actually caring for/talking to my pt-- just from chart.

Acute pain rt inflammation of pancreas aeb pt report of pain/ gaurding acitons

Imbalanced nutrition: less than body requirements rt nausea, anorexia, and vomiting aeb recent weight loss >10lbs

deficient fluid volume rt to nausea, vomiting and npo status aeb altered intake

ineffective theraputic regimen rt lack of knowledge of prevention aeb chronic problem

I have others that relate to her plethra of other problems, but I need to focus 2 on her admitting diagnosis. I was thinking pain and fluid deficiency.

Valerie Salva, BSN, RN · Mar 12, 2009

" I was thinking pain and fluid deficiency. "

Which of the two admitting DX could cause actual danger for the pt if it were not addressed?

That answers your priority question.

Daytonite, BSN, RN · Mar 12, 2009

deficient fluid volume r/t to nausea, vomiting and npo status aeb altered intake (physiological need for fluid)
- i would not list npo status as related factor. being npo is a treatment modality ordered by the physician and iv fluids would have been ordered as a counter measure for it. so, being npo is really not contributing to fluid loss.
- altered intake is not a term i would use. what does it mean? it implies the patient is eating and that is contrary to the npo status you listed in the related factor. your aeb items should always be proof, or evidence, of (in this case--dehydration which is what deficient fluid volume is all about) the nursing diagnosis which is actually the nursing problem.
- as a stranger, i should be able to come along and read your diagnostic statement and get a picture of what is going on with this person: (1) they are dehydrated (2) because they are losing fluids from vomiting, and (3) this dehydration has these symptoms: ____.

[*]imbalanced nutrition: less than body requirements r/t nausea, anorexia, and vomiting aeb recent weight loss >10lbs (physiological need for food)

anorexia is debatably a medical diagnosis and i would not include it as a related factor since medical diagnoses are not to be used in nursing diagnostic statements. i would find another more generic way to say the patient is not eating.

[*]acute pain r/t inflammation of pancreas aeb pt report of pain/ gaurding acitons (physiological need for comfort)

i would just say "guarding of abdomen"

[*]ineffective theraputic regimen rt lack of knowledge of prevention aeb chronic problem (safety need)

your aeb item which is the proof, or evidence, of the patient's regulation and integrating into daily living a program for treatment of [their] illness. . .that is meeting specific health goals is incorrect. a chronic problem is not evidence of failing to follow a plan of care. if it were then every diabetic, copder and person with rheumatoid arthritis and many more would be branded with this diagnosis. the evidence for this patient are things like continuing to drink alcohol when they know they are not supposed to, drinking huge amounts of caffeine when they shouldn't, knowing the dietary restrictions they are supposed to follow but don't.

also, check your text. you have a number of typos.

tbell2 · Mar 25, 2009

How do I win?

I chose fluid volume deficiet and imbalanced nutrition as my priorities. I got the assignment back and the instructor noted that they were too similar and I should not have used both. :banghead:

Daytonite, BSN, RN · Mar 25, 2009

How do I win?
I chose fluid volume deficiet and imbalanced nutrition as my priorities. I got the assignment back and the instructor noted that they were too similar and I should not have used both.

This is how you learn. Both nursing diagnoses had the same related factors which made them similar. Depending on her admitting diagnosis, go with the one that is most important and which will be focused on. Since the patient was NPO, fluids would be more relevant to focus on because the patient won't be eating for a while and food interventions are not practical to be instituted at this time.