Prioritizing nursing diagnosis

[cjewert]

I always have trouble with prioritizing my nursing diagnosis. For my Sim lab, my patient was diagnosed with acute asthma exacerbation. She was coughing up thick, yellow sputum. Her O2 sats started at 92% and dropped to 89%. She had a temp. of 100.9, BP was 148/88, RR was 38, P was 130. She was on 4L/m O2 with a progressive upward titration to maintain adequate saturation. The provider supected that she also had a respiratory infection. She was very anxious.

I used the nursing dx of 1. Ineffective airway clearance, 2. Ineffective breathing pattern and 3. Anxiety. Can anyone help with the rationale of prioritizing? I would appreciate the help.

[HouTx, BSN, MSN, EdD]

A good rule of thumb is to follow the same prioritization sequence used for emergency response... A(irway), B(reathing), C(irculation) and C(-spine). in that order. Does that help?

[AliNajaCat]

I'll give you a little hint: One of the reasons they ask you to prioritize items you deem needed in your plan of care is that they want you to have your ducks in a row, that is, be able to say why you made the decisions you made. There isn't always ONE SINGLE right way to prioritize a given set of overlapping diagnoses once you've made them ( you don't "pick" them, you know that, right?). Unless your scenario includes things like "Traumatic amputation with pulsating blood out the femoral arterial stump" and "risk for ineffective activity planning" in the same guy (well, OK, so he lost his leg because he planned a lousy activity, LOL, but you see my point), it's sometimes ambiguous.

So your faculty wants to know how you decide what's more important. Hearing your rationales based on your assessment data is important to them because those help them judge how you're coming along in this think-like-a-nurse thing that you're in school for.

So, in your case study, put yourself in this patient's shoes. You feel horrible, and scared, you're wheezing and coughing like crazy, and your oxygen level is bad without supplementation. What do you need your nurse to do for you first, and why? What nursing interventions will make you feel better fastest, and why?

(Yeah, I know, that's what you asked us. Let's hear your thoughts. Think out loud for a bit and see what comes out of your fingertips at the keyboard....)

[DesertRosee]

I agree with HouTx,

ABC or airway, breathing, circulation is a good way to remember how to prioritize your nursing diagnosis. Your Sim patient had respiratory issues so I would think that a nursing diagnosis related to respiratory would be my priority.

[AceOfHearts<3]

I was told to think about what is going to kill them first? Thats why as others have stated we think about the ABCs.

[AliNajaCat]

Let me see if I can add anything to my previous thoughts. So often the ABC types of interventions are related to implementing the medical plan of care. That's fine, we have to do that anyway, and this person obviously needs things that are prescribed by physicians or other authorized prescribers (oxygen, bronchodilators, RT, perhaps a mild sedative, perhaps antibiotics if indicated).

But this is a NURSING assignment. You have made NURSING diagnoses. What NURSING CARE will you plan and deliver/delegate for them?