Priority nursing diagnosis

[hpkts]

Hi, I am third year nursing student. I need help with choosing priority nursing diagnosis for a case study. scenario is that 40 years old single mother of 6 year old has type 1 DM, ESRD and has been getting hemodialysis three times a week since past one year. AV fistula on right forearm. Upon her return from dialysis, she appears lethargic and sluggish to answer nurse' questions. She is afebrile, BP is 96/52, R- 12, O2 sat 98% on room air. Hgb 92 and glucose 15 and lytes are within normal range. She is unemplioyed and lives with her mother who helps her taking care of her son. She indicated that she is more fatigued on dialysis days. She is rather withdrawn throughout the day and is reluctant to talk to nurse about what her chronic illnesses mean to her.

I have chosen "risk for infection related to invasive procedure and chronic illness"

"Risk for ctivity intolerance related to fatigue"

Its not indicated when the lab work was done as to me glucose needs to be addressed. She is on sliding scale insulin.

I need to apply orem theory to this case study and choose three to four priority nursing diagnosis. Any help will be appreciated

[RunBabyRN]

What do you think the priorities are here?

Yes, glucose of 15- YIKES. That is a snapshot in time, though, not necessarily the current glucose, since you said you don't know the timing of the labs. That said, everything in a case study is important, and something like that wouldn't be included if it didn't need to be addressed.

Are you allowed to use risk diagnoses as your diagnoses? Risk of infection isn't in your top 3 priorities with this patient. You'd follow standard precautions and aseptic/sterile techniques as appropriate, the same as you would with anyone. Unless her white count is part of this, and it's off the charts, and she's febrile, risk for infx isn't the way to go. What are the complications of the fatigue she's experiencing? I don't think she's at RISK for activity intolerance- it sounds like she may already be experiencing activity intolerance.

Is she able to care for herself? Provide for her own ADLs? How is she coping? How does she feel as a parent? Daughter? What is her role in the family? Look at her age and her role, lack of employment. Key words: withdrawn, reluctant, fatigued... Tease out all of the diagnoses that might relate to her, and then suss out the ones that seem the most pertinent.

[Esme12, ASN, BSN, RN]

I am willing to bet that is 15mmol/l which converts to 270mg/dl and the hemoglobin is around 9.2g/dl...OP are you in the US?

OP....What do you know about renal failure? What other co-morbidities exist with these patients? You mentioned the patient is diabetic....does she also have hypertension? (which is common amongst renal patients)

What in your scenario do you find unusual/abnormal that should be a priority concern?

Upon her return from dialysis, she appears lethargic and sluggish to answer nurse' questions. She is afebrile, BP is 96/52, R- 12, O2 sat 98%

What would the priority diagnosis be looking at this information?

[Loo17]

I always thought an actual problem would take priority over a "risk for" diagnosis.

Fatigue is common and almost expected in dialysis patients. The vitals are pretty normal in a dialysis patient as well (at least in the real world). Can you think if any actual problems related to these? The fatigue seems to affect this patients life, she has a child, cant work.