Prioritization of nursing care plan

[wjddnjs]

Hi all,

I'm a 3rd year nursing student, doing my (hopefully) last assignment of the course!!

This assignment is about prioritisation of nursing care plan.

I've got a case of a 34 year-old lady, who was diagnosed with a meningioma and had c-section 5 months ago. She is admitted to hospital for revision of the shunt and for a possible gastic ulcer. She has been experiencing increased nausea and vomiting over the last few weeks.

considering all her current condition physically, psychosocially, nutritionally etc., I came up with 5 nursing diagnoses. that includes;

Deficit fluid volume

Imbalanced nutrition, less than body requirements

Risk of falls

Activitiy intolerance & self-care deficit

Ineffective coping

Now, I have to prioritize those nursing diagnoses and provide rationale for that with supportive evidence from recent literatures.

According to Column, prioritizing care is an essential nursing skill and it is differentiating between problems needing immediate attention and those requiring subsequent action requires great skill and judgment.

So it can be done by dividing and putting the care practices into three levels.

1. Immediate first-level patient problem: emergency life-threatening and safety situations (e.g. ABC system)

2. Second level: concerns such things as mental status change, acute pain, acute uinary elimination etc.

3. Third-level priority: those that do not fit into the above two categories (e.g. lack of knowledge, loger-term problems with living activities etc)

According to that three levels of prioritization, I tried to differentiate my nursing diagnoses.

1. Deficit fluid volume

2. Imbalanced nutrition, less than body requirements

3. risk of falls

4. activity intolerance

5. self-care deficit

6. ineffective coping

Is this right??? please help me out with the assignment

gimme some tips in prioritizing care from you experiences

or if you know any good literature/websites about prioritization, please let me know!

thanks heaps always!!:heartbeat

[Suethestudent]

We were taught that a 'risk for' is lower priority than a 'happening now' even if the result of the 'risk for' is serious (in this case a fall). Activity intolerance leads to respiratory/circulatory compromise( atelectasis, DVT etc) so it is a serious ND. Ineffective coping is actually serious because it can lead to depression, anxiety (ie mental status alteration) but without your R/T and AEB details I can't be sure. Based on what you have given I would go for 1,2,4,6,5,3 which is fluid deficit, imbalanced nutrition, activity intol, ineffective coping, self care deficit and risk for falls.

I am sure you will get a variety of diverse opinions on this one! We are all taught in subtly different ways, even within a program.

Good Luck with your assignment.

[brhyde1961]

While I agree that the "risk for" is usually lower priority, it is dependent on what is going on with your patient. I have had Risk for falls be the priority and keystone issue. In your case if there is a fluid volume deficit, it is the top priority and can have a positive effect on some of the other ND when addressed. Have you done a causative web to help you sort this out?

[DolceVita, ADN, BSN, RN]

When you get your feedback from your instructor I would be interested to know what they thought. I would have gone for

Fluid

Falls

Activity

Nutrition

Coping

But that is knee jerk without knowing anything about the patient -- are they in hospital, home etc. and what was the result of the assessments. Our instructors are very keen we use our clinical judgement, as well as a a more standardized prioritizing.

[MissletoeLPN]

Does anyone know of a good website to help with priorization of nursing diagnosis....I actually have more trouble coming up with the rationalization paragraphs then putting them in order......ANY HELP WOULD BE GREATLY APPRECIATED....Im ready to pull my hair out!!!!!