Prioritizing Nursing Diagnoses

[>--stethoscope--o]

Ok, I have a 72 yr old pt walked in with hyponatremia with a history of stage 4 CKD. Has neuropathy, is anemic but taking injections for it. Has fallen before in the past and uses hearing aids and glasses. Has dyspnea when walking "too far". My question for you guys is would you prioritize all of this in the following order: 1.) Activity intolerance R/T imbalance btwn o2 supply and demand 2.)ineffective tissue perfussion 3.) Risk for falls 4.) impaired urinary elimination??? Am I on the right track?...Do I need to change the order for these?...[i do know these aren't full nursing diagnoses, I'm just asking to see if I'm on the ball with prioritizing these.] ...Feedback will be greatly appreciated.

[>--stethoscope--o]

How do you prioritize diagnosis?

[RN OR DIE TRYING :0)]

Maslow's Hierarchy of Needs could serve as a great guideline for trying to figure out what's most important.

Good Luck!

[>--stethoscope--o]

I've actually been thinking about that sense I last posted. Thanks. So far I've figured out ABC's come before safety because of maslow's hiearchy (sp?) of needs.. I thought this was going to be a piece of cake and am now seeing it's not. ...Someone please help.

[suzers26]

Personally this is the order i would use for these particular dx. Following Maslow's Hierarchy & ABC's, Tissue perfusion would be first because it deals with circulation. And keep in mind it's always a priority to deal with what's already happening opposed to what the risks are so I would put the risk last. 1.)ineffective tissue perfusion(physiological) 2.)impaired urinary elimination (physiological)3.)Activity intolerance R/T imbalance btwn o2 supply and demand 4.) Risk for falls

So that's my opinion for what it's worth, I'm in 2nd semester nursing so I'm no pro yet...but I'm working on it!

[>--stethoscope--o]

Where would risk for impaired kidney perfussion fit here? ... Would it be fitting for my patient? She isn't really at risk. Her kidneys are not being perfused properly already. I'm very confused.

[RN OR DIE TRYING :0)]

I think it depends on what the professor is looking for cause my professer stated that "Risk for Fall" should rank high since patient safety should always come first.

I wish I could be more helpful but I'm still trying to figure this out myself.

[suzers26]

Safety ia always a priority, however, when prioritizing nursing diagnosis maslow's hierarchy of needs should be a basic guideline. For Maslow's hierarchy, physiological needs should be met first, then safety needs, love & belonging needs, self-esteem needs and finally self-actualization needs. With multiple physiological needs the ABC's should come in to help prioritize, meaning Airway, breathing & circulation would take priority. This is where tissue perfusion would come in.

Risk for falls is definately a priority, however, if the tissue perfusion is inadequate & urinary elimination is a problem (which can both contribute to fall risk), not to mention activity intolerance due to inability to keep up with O2 demand (also a contributor to falls), and these are current problems that could actually be life threatening to your patient they would need to be addressed first. Not to say you wouldn't address the fall risk, but addressing the fall risk is useless if they can't breath and are going to die from failing to address the actual problem anyway. And as you can conclude from Maslow's hierarchy physiological takes priority over safety.

So, what I'm trying to say is safety always is A priority, but is not always THE priority. My logic to this is I think what would make sense to address first, and...as I said a bove, if they are going to die from a physiological problem going unaddressed or possible receive an injury (not even definite) from falling...what would you want someone to address first if it were you or your family?

[SNtil11]

ABCs come before Maslow's needs because without ABCs intact, you're dead, and if you're dead, safety isn't an issue.

Also if he's got CKD, it's likely that the activity intolerance is more "impaired gas exchange r/t fluid overload" although "fluid overload" is likely it's own nanda (obviously if he has s/s). but open airway first, then breathing, then circulation (because circulation is no good unless the breathing is providing blood with oxygen).

Hope that helps - good luck!

[mammac5]

I learned

ABCs

Patient Safety

Patient Comfort

Patient Preference

[>--stethoscope--o]

You guys, I found out the answer. You have to go to your admitting diagnosis. My admitting diagnosis was Hyponatremia so my first priority diagnosis would be Fluid volume excess. After that you would work your way down.

[suzers26]

ABCs come before Maslow's needs because without ABCs intact, you're dead, and if you're dead, safety isn't an issue.

ABC's are physiological needs, which is the first lvl to Maslow's hierarchy. Physiological needs are the literal requirements for human survival, including breathing, eating, homeostasis, ability to reproduce, etc. They would just come first in that category if there were multiple physiological needs not met.