Priority of Nursing Diagnosis

[fathernurse2b]

Which one will you put first?

Decreased Cardiac outpur r/t decreased contractility aeb weak peripheral pulses

or

Risk for ineffective ariway clearence r/t bronchospasm

I know a acutal diagnosis should come before a risk but i say he is at risk for ineffective airway cleareance b/c he has bronchitis but his resp is even and unlabored no color changes in nailbeds, lips, buccal mucosa and his sats are 97%

Help out a fellow nursing student

[Daytonite, BSN, RN]

a care plan is a problem solving process. you solve real problems first. always, always, always. otherwise, you are not acting rationally. so, your decreased cardiac output must come first and be treated first. the fact is that your patient should be having symptoms of congestive heart failure if they have a decreased contractility problem as the symptoms of their decreased cardiac output. weak peripheral pulses are a symptom of a problem with afterload and is a problem of the heart muscle pumping mechanism. you should re-word your nursing diagnosis to read

decreased cardiac output r/t altered afterload aeb weak peripheral pulses

or

decreased cardiac output r/t altered contractility aeb

[pick one or more: crackles, cough, decreased ejection fraction, decreased left ventricular stroke work index, decreased stroke volume, decreased cardiac index, decreased cardiac output, orthopnea, paroxysmal nocturnal dyspnea, s3 sounds, s4 sounds - page 27-28,

nanda-i nursing diagnoses: definitions & classification 2007-2008

]

here are two websites that have information on this diagnosis if you do not have a care plan book or nursing diagnosis book to refer to:

[color=#3366ff]decreased cardiac output and http://www1.us.elsevierhealth.com/merlin/gulanick/constructor/index.cfm?plan=09. you also need to look at the pathophysiology of heart as well as heart failure to understand how to use this particular nursing diagnosis because it has several components to it that you need to understand before choosing the correct etiology (related factor). if your patient has weak peripheral pulses you need to get an understanding of what afterload is. it has to do with the pumping action of the heart.

in any case, your sequencing still should be:

1. decreased cardiac output
   
2. risk for ineffective airway clearance