Putting diagnoses in priority order? Help!

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Hello all,

I'm pretty new here but I've been in nursing school for a semester and desperately need help with a case study! The patient is 80 y.o Male with a history of CHF and DM.

Post- Op abdominal surgery with a colostomy

delirium assessment

pneumonia, respiratory assessment

I have a list of nursing diagnoses like acute pain r/t surgery, ineffective peripheral tissue perfusion r/t immobility or abdominal surgery, anxiety r/t change in health, impaired gas exchange r/t decreased functional lung tissue, ineffective airway clearance r/t inflammation and presence of secretion, i also have risk for infection - invasive procedure

I have to put the top 4 in priority order. Am I on the right track here? I don't what 4 to chose! I can come up with 8 dx just for the pneumonia. How am I supposed to figure this out?! I'm so stressed out =[

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Always remember airway, breathing, circulation is top priority.

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Specializes in NICU.

ABCs then the 5th VS PAIN

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Specializes in LTC.

I came here looking for the same help.. for yours

ineffective airway clearance r/t inflammation and presence of secretion

is definately #1 if they can't breath nothing else matters.

Maybe someone can help me

Would you prioritize risk for infection r/t surgery in a possibly immuno compromised pt. over impaired physical mobility r/t to pain ?

My rationale is that even though the risk for infection is potentially more life threatening it is a "risk for" d/x vs. the immobility which is a very real and a significant issue for this pt. who is young and previously independant, additionally the immobility is not expected to clear up with the pain she is looking at a fairly lengthy stay in rehab but cannot even begin her rehabilitation due to hip pain so severe she cannot even sit upright. Think I'm going to go with the immobility over the infection. Please weigh in if you think his incorrect!

p.s. I already have pain as the #1 d/x

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Specializes in LTC.

Disregard the previous, I thought about it some more and decided to put risk for infection before mobility since at the time I saw her she was still in the hospital setting where keeping her pain& infection free would be the top goals in order to move her on to a rehab facility where the mobility will then become the higher priority, not sure if i'd prioritize differently if she were scheduled for discharge to home vs. rehab but in this case it is irrelevant.

Still feel free to comment if my rationale sounds flawed...I need all the help I can get!!

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The trick with prioritizing nursing Dx's is to not base it on the medical dx, but by your assessment. So, while you can come up with 8 nursing dx's for PNA alone....what assessment data were you given? Vitals, lung sounds, respiratory rate, Oxygen saturation, appearance (are they diaphoretic, are there breaths shallow or labored?), etc...

Nursing dx's should always be based on your assessment and not on medical diagnosis's because they're about the patient's reaction to the disease process and no two people react in exactly the same way.

Hello all,

I'm pretty new here but I've been in nursing school for a semester and desperately need help with a case study! The patient is 80 y.o Male with a history of CHF and DM.

Post- Op abdominal surgery with a colostomy

delirium assessment

pneumonia, respiratory assessment

I have a list of nursing diagnoses like acute pain r/t surgery, ineffective peripheral tissue perfusion r/t immobility or abdominal surgery, anxiety r/t change in health, impaired gas exchange r/t decreased functional lung tissue, ineffective airway clearance r/t inflammation and presence of secretion, i also have risk for infection - invasive procedure

I have to put the top 4 in priority order. Am I on the right track here? I don't what 4 to chose! I can come up with 8 dx just for the pneumonia. How am I supposed to figure this out?! I'm so stressed out =[

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Specializes in Gerontological, cardiac, med-surg, peds.

This really depends on your instructor, and whether he/she considers "Risk for" nursing diagnoses on an equal par to actual problem diagnoses. With my clinical groups, I tell students that "Risk for" diagnoses can sometimes be more critical than actual problems. This depends on how much a client is at risk and how life-threatening this risk is, should it occur. "Risk for Infection" with an immuno-compromised patient who just had surgery trumps "Impaired Physical Mobility" in my opinion.

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Specializes in LTC.

Thanks VickyRN that is what I thought too, but it's so easy to over think these things when it's new to you. Your agreement makes me feel much more confident about my case study. Thanks a million!

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OP, I would use Ineffective airway clearance number 1, then impaired gas exchange, then risk for infection, then tissue perfusion, then pain, then anxiety... I think thats all of them...

:0)

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Specializes in ICU.
OP, I would use Ineffective airway clearance number 1, then impaired gas exchange, then risk for infection, then tissue perfusion, then pain, then anxiety... I think thats all of them...

:0)

Tissue perfusion before risk for infection, right? Circulation?....

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Lord help me so that I may never make a silly mistake again. Thats right. tissue perfusion before infection...

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