Prioritization of Nursing Diagnosis pls!!!!

[2bnurse_kadz]

I have a list of nursing diagnoses which I need to prioritize 3.

Brief history: post-CABG pt, hx of IHD, Type II DM, AF, HT, angina, arrhythmia, GORD.

I have chosen impaired gas exchange as the first priority but I'm a bit confused as to what to place as 2 and 3 whether it would be acute pain, acute confusion, risk for falls, or risk for unstable blood glucose.

Here is the list of nursing diagnoses:

- acute pain

- risk for infection

- delayed surgical recovery secondary to infection risk

- risk for impaired skin

- acute confusion

- risk for falls

- risk for unstable blood glucose.

Help would be greatly appreciated!!! :loveya:

[Fig77]

I think acute pain since that is more physiological(maslow's) than the rest and technically as a nurse (or trying to become one) acute pain is happening right now compares to the other nursing dx that are only risk for this and that.

[2bnurse_kadz]

Thank you for your input Fig77.

so, the nursing priorities 4 my case would be:

1. impaired gas exchange

2. acute pain

For the 3rd nursing diagnosis should I prioritise:

- acute confusion rather than delayed surgical recovery secondary to infection risk? because the patient constantly removed his oxygen via the nasal prongs which may lead to hypoxia/hypoxemia.

[talaxandra]

I'd prioritise in order of risk to life/recovery, weighed by likelihood of outcomes. Reading that back it sounds like gibberish so let me give you an example - hypoglycemia hits fast and can be fatal, so if the patient is a brittle diabetic I'd put it high but if he's not on insulin or unstable then managing glycemic control is a lower priority than pain management. Pain management ranks fairly high partly for patient comfort but also because a post-op patient in pain is a grater risk of chest infections, DVTs and would breakdown (because pain interferes with sleep and reduces immunity).

Hypoxia ties in with your imapired gaseous exchange - if he needs O2 to maintain an adequate SaO2 but is removing the cannulae you need a plan in the first section as well as for management and prevention of acute confusion. I haven't had to do a care plan like this for... let's just say it's been a while. Can you bracket the confusion management into the first issue?

[2bnurse_kadz]

I was a bit hesitant with placing acute confusion as my first priority because of Airway, breathing, circulation as the priorities. But the reason why he desats is due to removal of O2 via nasal cannulae. So would you say that I prioritise as following:

1. Acute confusion

2. Impaired gaseous exchange

3. acute pain

Is this more appropriate for the scenario?

[talaxandra]

I think gas exchange has to come first - if that's compromised then it doesn't matter what else you do, in the same way that first aid prioritises airway then breathing. I just meant are you able to fold in management of confusion and/or preventing the patient removing the O2? That's the problem with an issues based approach that addresses each elelment of patient care individually - in real life issues tend to overlap a bit.

[2bnurse_kadz]

Well the patient was constantly monitored to prevent further removal of nasal cannulae & eventually the sats increased. What advice are u able to provide for my third nursing diagnosis? I feel that I should choose acute confusion.