plz help, prioritising nursing dianoses!!!

[radhika33]

Hi all,

Can anyone please help me prioritising nursing diagnoses that i have selected for patient with chronic obstructive pulmonary disease. The DX are : Ineffective airwaly clearance r/t excessive mucous secretion; activity intolerance r/t shortness of breath; imbalanced nutrition r/t dyspnea and disturbed sleep pattern related to breathlessness, anxiety, dyspnea".

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

Any help please??????

[Daytonite, BSN, RN]

You need to read the information about maslow's needs that i provided for you to understand the concept behind prioritizing these problems. maslow is broken down into what the person needs in order to sustain life with the first needs being physiological needs. the most important needs (physiological ones) are sequenced in order of the ones that will kill you if they are not met first:

• Physiological needs (in the following order)
  • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
  • the need for food and water
  • the need to eliminate and dispose of bodily wastes
  • the need to control body temperature
  • the need to move
  • the need for rest
  • the need for comfort

As you can see, the need for oxygen is primary. any patient problem that deprives someone of oxygen gets sequenced first, but there are different problems among them. the brain being deprived of oxygen is a more serious problem than the tissues of a foot being deprived of oxygen. why? the brain cells die in minutes when deprived of oxygen; cells of the foot take a little longer to die when deprived of oxygen and the body won't die immediately either, however, it will still cause serious problems.

Look at the next item on the list: the need for food and water. we can't live for very long without either. when people are hospitalized and made npo the docs still order iv fluids because people can live off their stored fat reserves, but they must have fluids or they will dehydrate pretty quickly over a few days time and die from the dehydration.

The next need is the elimination of body wastes. i have seen patients in chronic renal failure who have chosen to stop their dialysis and die. it only takes about 5 days for the toxins to build up in their system because of the renal failure and for them to die from it. a bowel obstruction left untreated will most certainly cause a person's death within a few days.

Are you getting the idea here? as you move through the list the needs become less life threatening. here is the entire list:

1. physiological needs (in the following order)
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
   • the need for food and water
   • the need to eliminate and dispose of bodily wastes
   • the need to control body temperature
   • the need to move
   • the need for rest
   • the need for comfort
2. safety and security needs (in the following order)
   • safety from physiological threat
   • safety from psychological threat
   • protection
   • continuity
   • stability
   • lack of danger
3. love and belonging needs
   • affiliation
   • affection
   • intimacy
   • support
   • reassurance
4. self-esteem needs
   • sense of self-worth
   • self-respect
   • independence
   • dignity
   • privacy
   • self-reliance
5. self-actualization
   • recognition and realization of potential
   • growth
   • health
   • autonomy

All of the nursing diagnoses can be classified and placed somewhere on this list. some because of the nature of the individual's particular circumstance may make the classification of the diagnosis more specific within a category. i have seen this when there are a lot of nursing problems identified and there may be 3 or 4 safety needs and a decision has to be made as to which safety need is more important than another safety need. however, with the diagnoses you have chosen the choice of classification is clear:

1. ineffective airway clearance [physiological need for oxygen]
2. (imbalanced) nutrition, less than body requirements [physiological need for food]
3. disturbed sleep pattern [physiological need for rest]
4. (chronic) pain [physiological need for comfort]

In prioritizing these problems you need to understand that the respiratory problem left unresolved is going to kill the patient fastest. next, the nutrition problem left unresolved is the next immediate problem. then, sleep. and, finally, the pain.

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

This will be based on the cause of the pain. you must assess the patient and know WHY they are experiencing the symptom. is it the osteoarthritis, the inflammatory response and damage caused by that disease process causing the pain? or is it the copd? you cannot relate the pain to the ineffective airway clearance which is caused by problems associated with the copd unless you can associate the pain with the copd and you have not provided assessment data that does that. and, something you haven't noted as well is if this pain is of a chronic (long standing) or acute (new onset) nature. there are two different nursing diagnoses for pain:

acute pain

and

chronic pain

-

Does anybody here have a pathophysiology for pain?

also, where is this pain that the patient will not cough? this is now very unclear to me. osteoarthritic pain is in the large joints; pain from constant coughing is intercostal and involves the muscles of the ribs. your initial assessment information is crucial to the nursing diagnosis. pain always needs to be assessed and described:

• assessment and description of pain includes the following:
  • where the pain is located
  • how long it lasts
  • how often it occurs
  • a description of it (sharp, dull, stabbing, aching, burning, throbbing)
    • have the patient rank the pain on a scale of 0 to 10 with 0 being no pain and 10 being the worst pain
• what triggers the pain
• what relieves the pain
• observe their physical responses
  • behavioral: changing body position, moaning, sighing, grimacing, withdrawal, crying, restlessness, muscle twitching, irritability, immobility
  • sympathetic response: pallor, elevated b/p, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, diaphoresis
  • parasympathetic response: pallor, decreased b/p, bradycardia, nausea and vomiting, weakness, dizziness, loss of consciousness

[radhika33]

Hi daytonite,

Thank you, thank you a lot for the clear explanation:). It is helping me lots and lots in completing my assignment.

I have one more question. I have two questions to answer seperately. First one is asking "why did I give the first 3 dx mentioned below priority over others". And the second is asking "why did i prioritize the first 3 (mentioned below) the way i did? "So my confusion is the answer for both of these questions sounds same to me? would u be able to tell me how am i going to answer them differently?

1. ineffective airway clearance.

2. imbalanced nutrition (less than body requirements)

3. disturbed sleep pattern.

4. Pain

5. impaired mobilit

6. activity intolerance

[Daytonite, BSN, RN]

"Why did i give the first 3 dx mentioned below priority over others?"

This is based on the assessment you did of the patient. after analyzing all the information you collected on the patient, this was the data that became the evidence of the nursing problems that the patient has. these are the 3 that came to the top of the list based on maslow's hierarchy of needs.

"Why did i prioritize the first 3 (mentioned below) the way i did?"

Using maslow's hierarchy of needs the problems requiring immediate physiologic attention were addressed according to his requirements for the survival of the human body.

However, now that you've added two more diagnoses, the list of priority has changed:

1. ineffective airway clearance
2. activity intolerance [physiological need for oxygen and circulation]
3. imbalanced nutrition (less than body requirements)
4. impaired mobility [physiological need to move]
5. disturbed sleep pattern
6. pain

[bagpipewilly]

Never mind me... trying to work the site.

[bagpipewilly]

Any sn out there that can help a poor, stupid male sn think of his next nursing diagnosis for his patient?

[Daytonite, BSN, RN]

bagpipewilly said:

any sn out there that can help a poor, stupid male sn think of his next nursing diagnosis for his patient?

Nursing diagnoses are based upon the assessment data you have on the patient. provide some specific assessment information (signs and symptoms that the patient is having) and I will help you. a good nursing assessment consists of you doing:

• a health history (review of systems)
• performing a physical exam
• assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
• reviewing the pathophysiology, signs and symptoms and complications of their medical condition
• reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking

The patient's signs and symptoms for determining their nursing diagnoses will be the abnormal data that is found during all the above assessment activity.

To see more on how this works, see some of the posts on