prioritizing nursing dx for pt. with ulcerative colitis

[lilredbedhed]

Hi Everyone, I am doing a concept map on a pt with ulcerative colitis and came up with these nursing diagnosis:

1.diarrhea related to intestinal inflammatory process

2.Chronic pain

3.Impaired Skin Integrity r/t diarrhea

4. Risk for deficient fluid volume

5. Knowledge deficit

I have all of my interventions and rationales, but I am having a hard time prioritizing them in order of importance....I am thinking the order in which I listed them...I know that deficient fluid volume is very important but it is just a "risk for" so I did not think it would come first...anyone up for some teaching!? It would be greatly appreciated! Thanks in advance!

[Daytonite, BSN, RN]

i prioritize by maslow's hierarchy of needs. to be on the safe side you should ask your instructors if using maslow to prioritize is ok in case they prefer you to use another reference. i am listing the hierarchy and a link to it last.

actual problems are sequenced first. a "risk for" diagnosis is an anticipated problem that doesn't exist yet, so must be sequenced last.

1. diarrhea related to intestinal inflammatory process
   
2. chronic pain
   
3. impaired skin integrity r/t diarrhea
   • the related factor of the altered epidermis (destroyed skin layers) is not directly due to diarrhea. it would be the moisture and chemicals in the diarrhea that are causing the skin to break down, but it sounds more professional to say diarrhea. see the related factors in a nanda reference or on this webpage for this diagnosis: impaired skin integrity

[*]knowledge deficit, specify

• the specific knowledge deficit must be stated. it can be such things as the medical condition, prognosis, treatment, self-care, discharge needs and any other number of things.

[*]risk for deficient fluid volume

this is the hierarchy (http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs)

1. physiological needs (in the following order)
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort

[*]safety and security needs (in the following order)

• safety from physiological threat
  
• safety from psychological threat
  
• protection
  
• continuity
  
• stability
  
• lack of danger

[*]love and belonging needs

• affiliation
  
• affection
  
• intimacy
  
• support
  
• reassurance

[*]self-esteem needs

• sense of self-worth
  
• self-respect
  
• independence
  
• dignity
  
• privacy
  
• self-reliance

[*]self-actualization

• recognition and realization of potential
  
• growth
  
• health
  
• autonomy