Priority Diagnosis Assistance

[eamxo]

Hello nurses! I'm hoping for some assistance here...after performing my assessment I was able to make 5 nursing diagnoses for my patient, and I'm now ranking them in priority order...my patient presented with intense abdominal (menstrual cramps) pain 10/10, reports of vomiting, weakness, fatigue, nausea, "a lot of stool, very soft" HR- 102 bpm and BP 82/60.

Here's what I've got so far:

1. Acute pain r/t cramping from hormonal effects AEB patient report of pain 10/10.

2. Deficient fluid volume r/t active fluid volume loss AEB patient report of weakness, vomiting, diarrhea, tachycardia and hypotension.

Im tripped up on which order I should place 3 and 4 ... they are:

nausea r/t prostaglandin effect AEB patient report of nausea and vomiting with menstruation

and

activity intolerance r/t generalized weakness AEB patient report of weakness and fatigue

and then my last one:

5. Risk for electrolyte imbalance related to active fluid volume loss

both 3 and 4 are physiologic and so Im not sure which should be higher. The nausea seems more uncomfortable, and is causing the vomiting and fluid loss which could be contributing to the activity intolerance...so should that be a higher priority?

This is my first semester and first assessment, so I'm hoping that im at least on the right track?

Any feedback, input or assistance would be greatly appreciated!

Thank you very much :)

[203bravo, MSN, APRN]

What would it take to resolve the weakness and fatigue? Do you think that it would resolve at all without doing something about the nausea and vomiting?

Think about if you were the patient what would you want to have done first....

[eamxo]

Thank you very much! That definitely points me in the right direction :)

[nurseprnRN, BSN, RN]

Another thing to remember is that sometimes there is no set-in-stone hierarchy. Part of your learning to plan nursing care is to be able to defend your priority decisions.

And always remember that the idea that "risk for" diagnoses are not "real" or "actual" and therefore are of much lesser importance is FALSE. A whole section of the NANDA-I 2015-2017 (which you must have) is devoted to safety, and most of those are "risk for" diagnoses. One of nursing's primary responsibilities is safety, isn't it?

I could make you a very strong case that "risk for electrolyte imbalance" could indicate nursing awareness of a potential condition that could be a lot more dangerous than nausea or activity intolerance, and that should be monitored closely.