plz help, prioritising nursing dianoses!!!

Fig77 · Oct 2, 2009

By usign Maslow's human needs concept i understand that "ineffective airway clearance" comes first in this list. But i dont know how to describe the reason why the dx "ineffective airway clearance" should be focused first by nurses?

because according to maslow's law, airway got the first priority followed by breathing and circulaation and any other physiological provlems. I would use my nursing textbook as a reference because I m sure it will mention maslow's concept. I think airway got the top priority because in it's absence there will be no breathing and circulation will end eventually as well, and all these three are imperative for sustaining a life.

SolaireSolstice, BSN, RN · Oct 2, 2009

We were taught ABCs then Maslows. ABCs = Airway, breathing, circulation. I know Maslows covers this in the first tier, but I just learned it better that way.

radhika33 · Oct 3, 2009

Thank you for your quick reply guys. I need some more help to expand on this. I need to describe in around 2000 words about why did i prioritize ineffective airway clearance over other two diagnoses " activity intolerance" and "disturbed sleep patern".

Please help me!!!

Fig77 · Oct 3, 2009

Maybe you can add your own detailed explanation to reach over 2000 words, but here is a basic rationale I would use

Airway is top priority because without oxygen circulating the patient will die in a matter if minutes. So activity tolerance and normal sleep pattern won't be relevant.

Sleep is next. Because without sleep and rest, you won't be able to perform physical activity and tasks.

Activity is important to enhance (not absolutely necessary) circulation. It is not necessary for survival. *

radhika33 · Oct 3, 2009

Thank you again for your quick reply friend. Do you think i should include pathophysiology of COPD to expand on my answer. I need good references as well to write my answer. What kind of words can i use to search the answer for this question because i have tried multiple times in the google, but couldn't find anything relevant to answer my question. I am really struggling to answer this question??

Fig77 · Oct 3, 2009

Thank you again for your quick reply friend. Do you think i should include pathophysiology of COPD to expand on my answer. I need good references as well to write my answer. What kind of words can i use to search the answer for this question because i have tried multiple times in the google, but couldn't find anything relevant to answer my question. I am really struggling to answer this question??

You can use copd if that is involved in this case scenario, otherwise use it as an example.

What semester studen are you? If you have taken physiology and pathophysiology already, refer to those books about how important the Airway (respiration & circulation) is. Without airway, our entire physiological systems (digestive, neurological, circulatory and everything) will shut down. Therfore, in the end we won't be talking about activity and sleep because we will be death. So airway is the top priority.

In your case scenario, sleep is the second priority. It is more important than activity. Without sleep (rest) we can't perform activity, or we will risk injury. Add other points here.....why sleep over activity.

Activity is important for the above two - airway and sleep, but not necessary. We can still breath in and out, and sleep without performing any activities(physical exercises/mobility).

For reference use textbooks, journal, and online nursing articles from library database.

radhika33 · Oct 3, 2009

thanks for your help mate. I am at the end of my fourth semester, second year. I have 2 more semester to go.

chaw!!:)

Daytonite, BSN, RN · Oct 4, 2009

the sequence should be as follows:

ineffective airway clearance r/t excessive mucous secretion
activity intolerance r/t shortness of breath
imbalanced nutrition r/t dyspnea
disturbed sleep pattern related to breathlessness, anxiety, dyspnea"

however, you have some serious problems with the construction of two of your diagnostic statements. a nursing 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. each nursing diagnosis will have specific related factors. the taxonomy will list the specific related factors for each diagnosis. pathophysiologies need to be examined to find some of 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.

activity intolerance r/t shortness of breath

shortness of breath is a symptom of activity intolerance and not a related factor for it. you need to look at the definition of this diagnosis to get a better understanding of what this nursing problem is. it has to do with a patient not having enough energy to perform activities of daily living. they become so exhausted that they must sit down and stop the activity (that is the activity intolerance) they are engaged in because they become sob, their b/p becomes elevated, heart rate becomes elevated, or they become so weak they cannot continue on with the activity. the cause could be an oxygenation problem, the effects of long term immobility, deconditioning or overall weakness. see the taxonomy for a list of the related factors for this diagnosis.

imbalanced nutrition r/t dyspnea

imbalanced nutrition is not an official nanda diagnosis. it must be specified as being either "more than body requirements" or "less than body requirements" and the related factor always has to do with the pathophysiological reason why the person is eating too much food or is unable to eat enough and dyspnea is not a specific enough reason as your related factor.

but i don't know how to describe the reason why the dx "ineffective airway clearance" should be focused first by nurses?

if the airway becomes blocked, air (

oxygen

) cannot get into the body and the cells,

particularly the cells of the brain

, will die in just a very few minutes. that is what makes this diagnosis a priority over others.

and also guide me what kind of reference i should look for to complete this kind of assignment?

http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

- maslow's hierarchy of needs

Fig77 · Oct 4, 2009

The sequence should be as follows:
Ineffective airway clearance r/t excessive mucous secretion
activity intolerance r/t shortness of breath
imbalanced nutrition r/t dyspnea
disturbed sleep pattern related to breathlessness, anxiety, dyspnea"

hi daytonite, i was wondering you could help us understand when prioritizing the nursing dx should we be look at the problem statement, r/t or aeb? Because I was thinking sleep has more priority over activity. Thanks for your help.

Daytonite, BSN, RN · Oct 4, 2009

You have to know what the problem (diagnosis) is and what the underlying pathophysiology causing it is. With something like Ineffective Airway Clearance and Activity Intolerance you are dealing with the Respiratory (Activity Tolerance) and the Respiratory and Circulatory (Activity Intolerance) systems. Those alone tell you they are top priorities. Respiratory system is dealing with oxygen delivery to the body. So is the heart. How long can you live without oxygen? 4 - 7 minutes.

Nutrition. . .you can live without food for days and without water for a few days.

Sleep. . .you can live without sleep for a lot longer than you can live without oxygen.

radhika33 · Oct 4, 2009

Wow!! such a thorough explanation, no body else other than my teacher could do it. You are now my teacher now mate!!:nuke:

Thank u for ur explanation abt "Ineffective airway clearance". I have already been able to expand on that by using pathophysiology book and have already made 400 words for my assignment:nuke:

Would you be also able to help me some more. In the scenario i have chosen, the patient has been diagnosed with COPD and osteoarthritis. Along with the dx, i have mentioned before, i have also added two other diagnoses for this patient (pain r/t joint swelling and impaired physical mobility r/t joint deterioration).

I am supposed to chose three dx among all of these and prioritise them, so i have chosen: 1."Ineffective airway clearance", 2."pain" and 3. disturbed sleep pattern/ nutrition, less than body requirements (i am not sure which i should prioritise among this last two) on the basis of Maslow's concept. Do u think my priorities are sensible? Suggestions please??

And, also, how will i be able to describe that i will on focus on "pain" after focusing on "Ineffective airway clearance" (as i think i should focus on pain after "Ineffective airway clearance" because the patient will not concentrate on clearing airway through coughing or other techniques when he will be in pain). I need to relate pain dx with "Ineffective airway clearance" as well :confused:

Sorry it is too long. This assgt is difficult one for me :banghead: