Prioritizing Nursing Dx's

Unknown member · Nov 30, 2010

Hello! I am working on my first care plan right now and for part of it we are to prioritize all of the nursing diagnoses we came up with from our assessment. Well I found a ton of abnormalities with my patient so I have a ton of dx's and I'm getting all mixed up with my priorities. I tried to do ABCs and then Maslows needs and put the actual dx's before risks (we were told to stay away from risk dxs but i think the 2 i have are biggies so im still going to throw them in there). anyways i would love to hear any suggestions about the order of the dx's or any of the dx's themselves.
My patient was a 70 yo female recovering from total hip replacement and small bowel obstruction due to postop mild ileus. Vitals were all within normal ranges. Thanks!!
Constipation R/T medication use and immobility AEB patient report of no BM in 5 days.
Acute pain R/T postoperative pain AEB patient reports of pain.
Impaired Tissue Integrity R/T surgical disruption of tissues AEB surgical incision on right hip.
Activity intolerance R/T reduced oxygen carrying capacity of the blood AEB hematocrit level of 32.9 and patient reports of fatigue.
Impaired physical mobility R/T pain and imposed restrictions of movement AEB limited range of motion.
Impaired skin integrity R/T shearing force of surgical tape AEB area of excoriation on right upper buttocks.
Urinary retention R/T high urethral pressure caused by disease AEB patient report of “dribbling”.
Self care deficit, dressing R/T musculoskeletal impairment AEB patient request for dressing assistance.
Disturbed sleep pattern R/T gender related hormonal shifts AEB patient report of difficulty falling asleep and staying asleep.
Imbalanced nutrition: More than body requirements R/T sedentary activity level AEB weight 20% over ideal for height and frame.
Bowel incontinence R/T immobility and medications (laxatives) AEB patient report of involuntary passage of stool.
Impaired urinary elimination, urge incontinence, R/T uninhibited bladder contraction AEB patient report “Sometimes I feel the urge and then I go before I even get a chance to get up.”
Disturbed sensory perception: kinesthetic r/t altered sensory integration and medications AEB patient report of vertigo once a month.
Risk for infection R/T surgical incision on right hip.
Risk for Acute Confusion R/T electrolyte imbalance AEB hyponatremia and hypochloremia.
Fatigue R/T poor physical condition AEB patient report “my energy level is in the cellar.”
Anxiety R/T threat to health status AEB patient statement “I’m nervous about getting another bowel obstruction.”
Ineffective coping R/T situational crisis AEB verbalization of absence of coping methods.
Impaired knowledge R/T complexity of therapeutic regimen AEB patient statement ““I do take vitamins and herbs. I can’t remember all of them.”
Impaired memory R/T neurological disturbances AEB patient reports of difficulty with “retrieval”.
Ineffective sexuality patterns R/T absence of partner AEB reported changes in previously established sexual patterns.
Readiness for enhanced self health management R/T altered health status AEB patient expresses desire to seek higher level of wellness.
Disturbed body image R/T change in appearance due to multiple pregnancies AEB patient verbalization of such changes in a negative way.

hey, this is a LOT of nursing diagnoses. i know your question asked about prioritizing but to be honest, some need to be re-written.

Acute pain R/T postoperative pain AEB patient reports of pain.

....pain R/T pain AEB pain?... the etiology cannot be "pain" if the diagnosis is "pain". and you must write the patient's pain scale (0-10) as the AEB.

and you never say "caused by disease" you say "secondary to diabetes"

Impaired memory R/T neurological disturbances AEB patient reports of difficulty with “retrieval”.

--- i also used impaired memory for my patient and my instructor said this was incorrect based on the age and information given. difficulty retrieving what? old memories, new information?? ....if anything, this should be low on the list of priority.

Ineffective sexuality patterns R/T absence of partner AEB reported changes in previously established sexual patterns.

---- again, this diagnosis is low priority.

in my OPINION, the highest priority on the list is Acute Pain.

i didn't see any regarding breathing or respiratory which are always highest priority.

i've been told "risks" aren't highest unless "risk for aspiration" following surgery.

ps. i'm a first semester NS student so i could be COMPLETELY wrong! haha :)

RNCEN · Nov 30, 2010

IMO, pain is first here and impaired tissue integrity is #2

brokenroads27 · Dec 1, 2010

this is what i think:

1. acute pain for sure (remember pain is the fifth vital sign)

2. impaired tissue integrity

the psych dx would be close to the last that you would look at because you need to help the patient physically before you concentrate on their mental issues. the risk for ones are also last because they are not actual problems at the time.

Rhody34 · Dec 1, 2010

Well- I have a question. How is the pt. rating their pain? Is it an 8 out of 10? Or 3 out of 10? Whats a tolerable pain level for this pt? The reason I ask is because if the pain is "tolerable" I see some of the other diagnoses as a higher priority.

You have a pt. who is post op with limited mobility. She is obese and has some skin breakdown already. Because of poor nutrition status she will most likely have poor healing. I would say this pt. is a high risk for infection. If the pain is tolerable, I would say:

1. Impaired skin integrity

2. Impaired tissue integrity

3. Risk for infection (only ranking this lower because a risk is not an immediate need compared to more immediate needs)

Now- I'm only finishing up my first semester of the nursing program- so my knowledge is limited- but this is what came to mind when looking at what youve got. We have to rank our NDs too! Good luck!

TerpGal02, ASN · Dec 1, 2010

Depending on how the pt is rating their pain, I might swap #1 and #2. Constipation needs to be before skin IMO esp since she has not had a BM in 5 days. She needs to get those bowels moving stat or risk impaction, a possible perf, or sepsis.

I had a pt this semester that had not moved her bowels in 4 days and that was a HIGH priority of my instructor on day 2. I had constipation way down on my list and her comments on my care plan were that it should have been #1

CrazierThanYou · Dec 2, 2010

So far, we have only had to do 3 nursing diagnoses on our patients. But, we have been told that pain will almost always come first.