Priority Dx for end stage leukemia "comfort care only"

nurseprnRN, BSN, RN · Feb 27, 2012

i think ineffective health maintenance is supposed to be for things the patient can do or get done by changes in behavior (lke health-seeking) or self-management. if this gentleman is endstage leukemia, i'm not sure that works, but if you want it and can defend it, certainly keep it.

for my money, it's not always possible to say what the most important nursing diagnosis is when so many are clearly important. so my advice is usually to prioritize them the way you think, and then defend them with lots of data and rationales for your assessment. if your diagnoses are really out of whack, you will get that feedback (like, oh, worrying about body image or role change when there's huge active bleeding going on..no lie, i've seen that). lists are so...linear. it would be cool if we could make our nursing plans of care three-dimensional.

that said, my priorities would be improving his comfort and helping with anxiety, and the others are subsets of those. does that make sense? you will doubtless get other lists.

CT Pixie, BSN, RN · Feb 27, 2012

Think of Maslow and your're ABC's. And actual are higher priority than Risk for.

The most important ones I would look at I don't see you having listed:

Deficient Fluid Volume (although with comfort care for end stage CA I doubt they will be pushing fluids)

Pain should be one of your dx even if he's only complaining of pain while eating..he is still in pain.

Impaired skin integrity

why does he have diminished breath sounds? Is he on O2? How can you make it more comfortable for him to breath..(HOB elevated, O2, etc)

on eagles wings, ASN, RN · Feb 27, 2012

guys thanks!!!:redbeathe yeah this was a real challenge for me because I really wanted to concentrate on his comfort. he doesn't even have an IV port so no, he isn't receiving fluids. :-/ otherwise i would go for that one, it would be perfect...

wow why didn't i think of impaired skin integrity? that's huge! actually this is really big, apart from the pressure ulcer, the brusing is pretty bad and actually he has some open wounds on his arms. thanks guys you helped me look at this differently. :-)

ClearBlueOctoberSky · Feb 28, 2012

What is his platelet count? He has thrombocytopenia with evidence of active bleeding problems r/t the decreased platelet count.

Esme12, ASN, BSN, RN · Feb 28, 2012

maslow's hierarchy of needs - enotes.com virginia henderson's need theory

maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization – e.g. morality, creativity, problem solving.
esteem – e.g. confidence, self-esteem, achievement, respect.
belongingness – e.g. love, friendship, intimacy, family.
safety – e.g. security of environment, employment, resources, health, property.
physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

maslow’s theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. abraham lincoln, thomas jefferson, albert einstein, eleanor roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions

CT Pixie, BSN, RN · Feb 28, 2012

Self-actualization – e.g. morality, creativity, problem solving.
Esteem – e.g. confidence, self-esteem, achievement, respect.
Belongingness – e.g. love, friendship, intimacy, family.
Safety – e.g. security of environment, employment, resources, health, property.
Physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis.

For reference for any pre-nursing or just starting nursing school, I just want to add that the list above is showing the highest level first. The last one listed (physiological) is deemed the most important and has to be met before the next (Safety) can be met.

So for nursing care plans you need to address them in the reverse order they are listed above:

Phyiological

Saftey/Security

Belongingness

Esteem

Self-actualization

on eagles wings, ASN, RN · Feb 28, 2012

wow. i will make it a habit to look for my priority based on maslow's. makes a lot more sense and really makes it much easier to organize in my mind.

i think i am going to stick to impaired skin integrity. he is always guarding his arms because they are very bruised and bleed easily. he has a pressure ulcer and talked to me about how he bleeds internally and stuff. he is suffering very much for that.

ambgirl2nurse, he has no labs in his chart, he is comfort care only, doesn't even have an IV line. and he is DNR. =/

ay you guys are so helpful! :-)

Esme12, ASN, BSN, RN · Feb 28, 2012

For reference for any pre-nursing or just starting nursing school, I just want to add that the list above is showing the highest level first. The last one listed (physiological) is deemed the most important and has to be met before the next (Safety) can be met.
So for nursing care plans you need to address them in the reverse order they are listed above:
Phyiological
Saftey/Security
Belongingness
Esteem
Self-actualization

Build the pyramid from the bottom up.

on eagles wings, ASN, RN · Feb 28, 2012

me gusta :up: