Priority Need

[yula]

I have trouble finding the priority need in this case.

I think rest&sleep, spirituality, activity&exercises are three needs in this scenario. At first, I thought spirituality of ineffective coping was the priority need and nursing diagnosis but getting confused with activity &exercise

Patient E is a 66 year old woman who has just been admitted to the rehabilitation unit after undergoing a total left knee replacement 5 days ago. She has a history of osteoarthritis. The transfer report from the acute unit notes that her pain has been controlled with Tylenol #3 and her physiotherapy has been going well but the therapist has recorded that she is slow to complete her exercises. Patient E says she has been feeling really fatigued with little energy. During the admission assessment she repeatedly asks the same questions to the nurse while being orientated to the unit. She says that the pain in her left knee is a 4 or 5 out of 10”. She states she is very tired but says she will not take any medications to help her sleep because she does not want to be hooked on drugs.” In addition she states my partner died suddenly six months ago and it has been very straining both financially and emotionally, I barely sleep at night. I know I'm not coping well, but I don't know what I should do.” She has a brother that comes to visit every other day and two children living away, attending university. Her vital signs are as follows: BP 168/94, RR20, HR 106 T 36.8°C.

His medication orders are:

Acetaminophen 300 mg + Codeine 30 mg po Q4H prn

Ibuprofen 400 mg po Q8H

[Scottishtape]

I would say the priority here is Risk for Injury.

Shes got osteoarthritis, fatigue, recent knee replacement, confusion (repeatedly asking the same questions)and is on Tylenol #3. All of these things place her at a high risk of falls.

You've got a knowledge deficit r/t sleep aids, and ineffective coping r/t the death of her partner.

Those are just off the top of my head, and where I would start.

ETA: Try to think about priority nursing dx as those that will affect the patient the most. So, if you have a list of 4 nursing dx, and one of them is Impaired gas exchange, that one would be the priority. Why? Because of ABC's (airway, circulation, breathing). Having an impaired gas exchange will affect the patient more than say, anxiety would.

So, in pt E's case, what will affect her most?