allinoneplace01

Thanks for the broadened scope. I rotate in 5 hospitals in the fall, so I certainly will compare further. Thanks. And, I will look further into the clinical RN book. I meant to say my educational clinical curriculum at hospital follows NANDA r/t my clinical book.

I apologize if I came off wrong. But, "jensmom" two wrongs do not make a right. One team, one fight. I am simply learning. I feel that other hospitals have different structures, is all. Perhaps because it is finals week my wording was in error. I feel unsure.

I agree that my Diagnosis, r/t soiled underwear, as evidenced by (this portion needs better wording -- I should state as evidenced by facial expressions of ex. embarrassment). You are completely correct, I definitely messed up there! Now, for another topic, non-verbal cues, can they be included as evidence? I do not see why not because communication is 90% non-verbal.

Please define why soiled underpants does not relate to human dignity. That makes no sense to me.

Pressure ulcers are localized injury to the skin and/or underlying tissue usually over a bonyprominence (e.g., the sacrum, trochanter, ischium, or heel), as a result of pressure, or pressurein combination with shear and/or friction. In 2009, the National Pressure Ulcer AdvisoryPanel (NPUAP/EPUAP) defined a pressure ulcer as localized injury to the skin and/orunderlying tissue usually over a bony prominence, as a result of pressure, or pressure incombination with shear. Friction generates shear and when friction is high, the shear is alsohigh, so the inclusion of shear presumes the presence of friction (L. Edsberg, personalcommunication February, 2010; WOCN, 2010, p. 1). Either or, the patient has an ulcer. Can you change that? If I put friction ulcer, how can you tell? And it was over a bony prominence, but primarily was from the combination of pressure and friction with friction being predominant for stage 1 ulcer. I am going to go with the guidance of the hospital, the CI, the professors. And, to project against a PhD is immature, because she has practiced for more years than yourself. And the Lead RN, and the CI state support and I noted the reasons. I am sure that at your hospitals, and your experience you may be correct. At the hospital I am at your diagnoses priority would be incorrect. I am not going to project against your experience, or if you have a PhD or do not. And for a quote, "Half of what you learn today [. . .] will either be dead wrong within 5 years of your graduation." Perhaps, the learning structure has changed. They still call degenerative joint disease as osteoarthritis, but the terminology has changed. And, where I go to school, or a PhD, please continue on with the mentality of projection -- b.c. it suit you. Education is a gift, and some institutions may have different standards than other hospital institutions. Of course, if I go to another institution and they tell me to notate a different way I will adjust. Take care.

According to the head RN, and my clinical instructor (with 20 years teaching), and at one of the best hospitals (in the top 10) in the country: they said I should not change it, and that I was correct and they would prioritize human dignity as number 1 (as well). Maslow is a psychologist. I should follow the RN theorists. They also mention that interventions are also a factor for consideration of diagnoses ranking. I followed up with someone who has a PHD, 3 specialties, an MPH, and a few more and she said absolutely Human Dignity would be number 1 in the 3 I provided as a list. Now, she did say that some hospitals may follow Maslow guidelines, but according to my location they follow Nanda. So, in your scenarios/hospitals your ranking may be precise to your hospital's criteria. Thank you for the new knowledge about other hospital's criteria. Have a good week.

Thank you! I will definantly remember the maslow, esp. if is 95% effective. :)

Fun facts: I will know in a week or two.

I will certainly update with what the CI mentions. I will post the literature at a later date, have a few exams and finals coming up. It is a textbook of NANDA Diagnosis, and priorities for NANDA ranking . But, overall there is a higher importance "maslow's hierarchy of need, that you mention is r/t NANDA" but for the depth of the friction ulcer this was stage 1. There was no tunneling, etcetera. But, if I am brought a patient with inguinal friction ulcer that was noticed while bathing (I would believe the diagnosis as evidenced by the soiled) would be higher priority because of the interventions (I would change the patient). I would want to do the most important interventions. I can assess the friction ulcer after I clean the patient up. Due to the depth I don't think it is critical to rate the ulcer diagnosis higher. I feel they can shift the ulcer diagnosis in priority, so I can clean up the patient. Or, in all cases does "human dignity" always fall below a friction ulcer (stage 1) because of the "hierarchy of needs"? Thoughts?

Well, according to Nanda it is ranked number one (numerous literature). And, in my humble opinion, changing the soiled would be highest priority before assessing a friction ulcer that developed over time. You don't just let someone sit in their own "soil" you fix the problem that is most pressing. Adding friction lotion, or wiping a little moisture, is not more pressing than changing someone being discharged in their own soil. No theology would persuade me and I would happily take a mark off. Submitted Wednesday. Thanks for everyone's time.

She said priority, I re-referenced the syllabus. I assumed that was chronological. I do step A and then step B and then Step B, chronologically, with reference to time and priority. That aside, I will be submitting tomorrow. I placed Human Dignity diagnosis as number 1, since I feel that is pinnacle to our profession (or in my case future profession).

I was asked to have chronological in order of importance, according to the school

Nursing Diagnosis One: Tissue Integrity, Impaired, related to (Braden scale of 9, Obesity, Immobility in bed) as evidenced by friction ulcer 1cmX.5cmX1mm. Nursing Diagnosis Two: Urge Incontinence related to decreased ability to control urination associated with decreased level of consciousness as evidenced by patient ANOX2 (Person, Place) and voiding in diaper/disposable underwear 2X in 2 hours. Nursing Diagnosis Three: Human Dignity Compromised related to perceived humiliation during Emergency Room Transfer process as evidenced by soiled disposable patient underwear. I am asked to place these in order of chronological importance. I believe this is correct, but I am also debating number three should move to the number one. What are your thoughts + thank you for your time