Priority Nursing Diagnosis

[LilyNHRN]

I have a big care plan due soon and I am confused as to which diagnosis should be my priority.

My patient is an 89 year old female with total left hip replacement after left hip prosthesis failure. She lives alone.

Here are the two I am stuck at

Impaired physical mobility

Or

Self Care Deficit

I appreciate any feedback you can give. If you think I am missing the boat please tell me.

Thanks

[NaomieRN]

I would do selfcare deficit related to impaired mobility status

Patient will:

Identify individual areas of weakness/needs

Verbalize knowledge of healthcare practices

Demonstrate techniques lifestyles changes to meet self-care needs

Identify personal.community resources that can provide assistance

Good luck to you

I am a first semester nursing student, I hope I was able to help you.

[Daytonite, BSN, RN]

What self-care deficits are you looking at for your patient? I would consider self-care deficits in bathing, hygiene, dressing and grooming to belong more in the comfort area and, therefore rank below priority to Impaired Physical Mobility. Also, if Impaired Physical Mobility is a cause of the failure to perform of any of the self-care deficits I've just listed than it ranks in priority over them.

Self-care deficits of feeding and toileting need to be looked at a little closer. Nutrition (food) is an essential physiological need (per Maslow) and ranks second in priority to the need for oxygen to sustain life. Elimination ranks right below food. If these are self-care deficits that are major contributors to the patient's food and elimination needs than I would rank them over the Impaired Physical Mobility.

In fact, while you can use Impaired Physical Mobility as a nursing diagnosis in and of itself to address all the patient's self-care deficits under one umbrella, I would separate everything. Put your self-care deficits in their own nursing diagnoses. Leave the patient's problems with walking, turning and/or moving into or out of bed for the Impaired Physical Mobility nursing diagnosis. In other words, use Impaired Physical Mobility for his/her gross physical movement and the Self-Care Deficits for the impairment with his/her more finite physical movements. Doing it this way, I would rank them as:

1. Self-care Deficit: Feeding
   
2. Self-care Deficit: Toileting
   
3. Impaired Physical Mobility
   
4. Self-care Deficit: Bathing/Hygiene
   
5. Self-care Deficit: Dressing/Grooming

Does that make sense to you? Make sure you have the assessment data to back up each nursing diagnosis.

[LilyNHRN]

Thanks so much for the responses. I have decided to do impaired mobility and I will work self care deficits into that, I ran it by my instructor and she agreed with me.

Thanks again, it is so nice to have a forum to throw around idea's in.

[emtb2rn, BSN, RN, EMT-B]

I'm a little baffled here. Not about prioritization but about the how long the OP gets to develop the care plan. F'rinstance, I just got home from doing my chart research/talk to the RN/say hi to to the pt. I need to have my care plan ready to go at 0700 tomorrow morning. That's dx's/goals/interventions/rationales. If my pt isn't still on the floor (which happens somewhat frequently to me), I get an hour to do my research on a new pt and then have until post-conference to build the care plan (yep, do it at lunch and work backwards toward some of the evaluations I did in the am relative to my interventions). Isn't this the norm? It seems the OP has at least a couple of days to build the care plan. No disrespect intended, just not sure how/why the schools approach this differently. If it matters, I'm in a 2 yr diploma program that launched us straight into clinicals and has excellent NCLEX and placement scores.

[LilyNHRN]

I am not sure what an OP is. I can tell you that we don't have to create a careplan until after we have taken care of our patient. We don't know who our patient is until we arrive on the floor Monday morning. We turn our care plan in on Wednesday. I too am in a two year associates program, this being my senior year.

[emtb2rn, BSN, RN, EMT-B]

I get it now. Our schools simply have different approaches. My school wants us to create the careplan before we actually take physical care of the patient. Our 1st semester is pretty mellow, we're only with the patient(s) for 1 day/week. The previous clinical day is research. That will change next semester when we do full patient care over 2 days (R & F) with the research being done the previous afternoon (W).

OP stands for Original Poster.

NH, huh? Ski Tucks? I try to get up at least once a season, but school's gonna probably interfere for a couple of years....

[LilyNHRN]

Yep different approaches.

I dont' ski but my kids snowboard and my oldest would love to do Tuckerman's.

Well I must get moving have a great day!

[Nrs_angie, BSN, RN]

Hi there,

I guess I am replying to this thread a little too late since your care plan was already due by now....

However, just an opinion of mine I'd like to share. When prioritizing, you should always approach it by thinking of the ABC's first... airway, breathing, and circulation. Since I assume, we are talking about a post-op patient then we might also want to look at safety and pain. Those are two biggies on JCHAO's agenda right now! NCLEX is also testing your ability to prioritize by looking at ABC's and SAFETY!

Some of the Nanda nursing diagnoses that I think apply here are as follows:

1) Acute Pain r/t possible edema, physical injury, or surgery.

2) Risk for neurovascular Injury r/t altered peripheral tissue perfusion.

3) Risk for physical Injury r/t altered mobility.

Why did I choose this specific order? Well because pain is always a priority. Yes Impaired Mobility is an important problem, but the patient can not move very well if they have little pain relief right???

Secondly, Actual diagnoses come before Risk for diagnoses. So that's why Pain comes before Injury. But since we are focussing on safety, these are more important than self care defecits... For example, yes your patient may have difficulty walking to BR to void... but making sure they don't fall and break the hip again is more important.

Lastly, ABC's! Circulation and Neuro checks after surgery of any extremity are a priority. If damage has occured to the nerves that innervate the muscles, or the vessels that supply circulation to the extremity, we would be more concerned by that than their mobility at this point in time.

Of course, imparied mobility and self care deficity would then be the next choices when prioritizing.

Again, just my opinion. Hope you find this helpful.

Angie

[LilyNHRN]

Thanks Angie for the response. I would have used pain except that I had already used that for a patient so I was choosing a different diagnosis just to spread my wings a bit. Your information is very useful and I will and will keep trying to approach my diagnosis in that priority. Thanks so much for taking the time to reply.