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Discussion

Prioritizing my dx

I came up with 10 nursing dx, and have managed to wrestle them into priority order. I think. Can anyone give me good reason to switch things around, or does it look okay? the PT is s/p bilat PE.

1. Imbalanced nutrition: more than body requirements related to excessive intake in relation to metabolic need as evidenced by BMI of over 42.

2. Risk for ineffective peripheral tissue perfusion related to recent pulmonary emboli.

3. Ineffective peripheral tissue perfusion r/t impaired arterial perfusion as evidenced by cool distal extremities; loss of hair on lower extremities; dependent edema; hard, thick nails.

4. Ineffective health maintenance related to insufficient resources (finances, housing) as evidenced by he has no employment; he was recently homeless.

5. Impaired comfort related to altered health status as evidenced by report of chronic back and knee pain.

6. Ineffective coping related to feelings of sadness as evidenced by states [it] "seems like I just gave up doing anything."

7. Risk for loneliness related to social isolation.

8. Grieving related to loss of a significant other as evidenced by losing his wife; alteration in activity level; suffering; relating that his wife helped him keep it together.

9. Ineffective coping related to situational crisis as evidenced by becoming widowed; his dog being put to sleep; recently being homeless.

10. Stress overload r/t multiple stressors as evidenced by losing his wife 15 months ago; his dog being put to sleep; living with his grandson and the grandson's girlfriend and children.

Thanks for any thoughts. I'm so close to being done with this care plan I can taste it.

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    Select and prioritize according to the ABCs and Maslow.

    Do you really need 10? Do you have to write goals and interventions for each? If so, all I can say is wow...that's a lot of work.

    I don't understand why you have both #2 and #3. If he already has something he can't also be at risk for it.

    What about the rest of his health status besides the PE? What else does he have going on? Why did he get a PE? With his obesity is he diabetic or have hypertension? How's his airway and pulmonary function?

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    We have to pick 5-10, so I just came up with 10. We have to do two dx with interventions (5 per dx), and come up with at least one modification.

    What about the rest of his health status besides the PE? What else does he have going on? Why did he get a PE? With his obesity is he diabetic or have hypertension? How's his airway and pulmonary function?

    He's got DM, but not htn. His BS is under pretty good control. Airway is good, pulmonary function good. 97% on RA. He was on 2L via nasal cannula but the d/c'd that before I saw him. Basically, it sounded like he was going to be released and go home on warfarin.

    Aside from the PE, for which he didn't seem to have risk factors, he's in pretty good shape for a guy that overweight. I'm more concerned with his social and emotional health than the physical stuff. Mostly everything physical is chronic, the emotional stuff is more recent. It's hard.

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