Prioritization issues!

This is good practice. This is something you will be doing at every minute of your shift. Think of it like this, if you had these five patients, and you are coming on shift, who would you see first? Which of these patients is priority? In other words, is there a patient that requires a nursing intervention right away? Is there a sudden onset of something with one of the patient’s (something new) or do you have five patients with long-time problems?

I am trying to word it so that I do not give away the answer. So, what are your thoughts?

In addition to Parker, think of what are your ACTUAL vs POTENTIAL problems; you want to address actual problems first.

Use the proper terminology for your work. Actually, you have to do this, and when you do, prioritizing will come more easily to you.

I am having a hard time prioritizing my diagnoses, any input would be appreciated. Thanks!

1. Urinary retention r/t enlarged prostate AEB coudé straight catheterization 3-4 times per day and bladder distention with patient report of urgency and lower abdominal pain.

R/t: blockage (from enlarged prostate), check, appears on list of related (causative) factors in nursing diagnosis "Urinary retention," page 202, NANDA-I 2012-2014

Defining characteristics (as evidenced by): bladder distention and sensation of fullness, check; catheterization data is not on the list of defining characteristics.

2. Impaired physical mobility r/t generalized muscle weakness AEB history of falls, one assist with EZ stand, inability to reposition self in bed, use of a wheel chair, strength of UBE 3/5, strength of LLE 3/5, and strength of LRE 2/5.

R/t: "Musculoskeletal impairment" (not "general muscle weakness") appears on the list of related (causative) factors for nursing diagnosis "Impaired physical mobility," page 224, ibid. See also nursing diagnoses for "impaired bed mobility, "impaired wheelchair mobility," "impaired transfer ability," and "Impaired walking." Each has specific defining characteristics.

Defining characteristics (aeb): "History of falls" does not appear in list of defining characteristics for this diagnosis, nor does "one assist with EZ stand" or "use of wheelchair." "Limited ability to perform gross/fine motor skills" does appear, and you would add your (examination findings) in parens to specify to what degree they are limited.

3. Acute pain r/t impaired mobility and inability to reposition self AEB patient report of achy lower back pain of a 6 on 0-10 scale, patient reports pain's onset is while in bed for extended periods of time without changing position.

R/t: "Impaired mobility and inability to reposition self" do not appear in the related (causative) factors for the nursing diagnosis "Acute pain" on page 478, ibid; they do not cause pain. Look up what you can use in the book on that page.

Defining characteristics (aeb): "Reports pain" appears in list of defining characteristics. You can put your (assessment data) in parens after that.

4. Fatigue r/t uremia and anemia AEB patient report of drowsiness and lack of energy, BUN 41mg/dL, creatinine 2.30mg/dL, GFR 29mL/min, RBC 3.75 million, and HGB 12.4g/dL.

R/t: "Anemia" appears on the list of related (causative) factors for the diagnosis of "Anemia" on p. 229, ibid. "Disease states" also appears (Uremia).

Defining characteristics (aeb): "reports overwhelming/unremitting lack of energy, reports feeling tired," "Increase in rest requirements," and many others in list of defining characteristics.

Anemia, uremia, and labs are not evidence of fatigue and so they are not on the list of defining characteristics, but could be put in parentheses with "(anemia ...") and "(uremia...)"

5. Self care deficit r/t generalized muscle weakness AEB one assist with EZ stand to transfer, inability to dress and undress self, inability to toilet self, inability to bathe self, and inability to reposition self in bed.

There is no such nursing diagnosis as "Self-care deficit."

However, there are several related nursing diagnoses: Dressing, bathing, feeding, and toileting self-care deficits, pp 250-253, ibid. Each includes "musculoskeletal impairment" in the list of related/causative factors; there are others.

Each has its own specific list of defining characteristics. Repositioning self in bed is part of the "impaired bed mobility" nursing diagnosis, note above.

Are these actual pts you had and then had to write diagnoses and prioritize them? Or were you give scenarios that you had to make up diagnoses for? I ask because I'm curious especially for #4:

4. Fatigue r/t uremia and anemia AEB patient report of drowsiness and lack of energy, BUN 41mg/dL, creatinine 2.30mg/dL, GFR 29mL/min, RBC 3.75 million, and HGB 12.4g/dL.

with those labs (and the disease implications they represent) - is fatigue really going to be the priority diagnosis for that patient? A GFR of 29mL/min indicates what? (hint - it's an undesirable stage of a major failure) What other (higher priority) problems would you expect to see (or did you see, if this was a real pt) with this? Is there edema? (Fluid volume excess?) What's the potassium like? (and what other body system would you see affected if it's abnormal?) This pt might well be the priority, but not with the fatigue diagnosis - there's likely more pressing problems.

If this pt gets cathed multiple times a day, is he at risk for infection?