RN Diagnosis Chronological order

MendedHeart · Jul 23, 2015

Your a student, learning. We are Nurses who have the experience of Nursing school and real life.

First of all, you are not bring humble with the above statement.

Secondly, nobody is telling you to allow a patient to sit in their own feces.

Cleaning a patient up is an INTERVENTION, not a Nursing Diagnosis.

The active Wound is higher PRIORITY . Keeping a patient clean and dry is an intervention for Wounds and an intervention for Dignity.

Do you understand what I'm saying?

nurseprnRN, BSN, RN · Jul 23, 2015

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.

I'm not exactly sure what you mean here. It appeared to me that you were making your priority nursing diagnosis thus:

I placed Human Dignity diagnosis as number 1, since I feel that is pinnacle to our profession (or in my case future profession).

I'm not seeing any NANDA-I hierarchy in the book that rates any nursing diagnosis "number one," so did you mean that the tissue integrity was, after all, first, as you listed them in your original post? That was my recommendation, and addressing it would include keeping the skin clean and dry.

Well, let us know what feedback you get from your CI. I'd be interested.

allinoneplace01 · Jul 24, 2015

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?

allinoneplace01 · Jul 24, 2015

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

MendedHeart · Jul 24, 2015

Your still not understanding. It is very important to keep the patient clean and dry however those are interventions.

You were asked to prioritize Nursing Diagnoses, not interventions. Unless you were asked to come up with a care plan, you do not need to even think about the interventions at this point.

Prioritizing Nursing Diagnoses is based on what is the most important need of the patient based on your assessment.

You would have already assessed the wound prior to making a Nursing Diagnosis from it.

Also, Maslows hierarchy is the best reference. Wounds/physiological/safety needs always come before psychosocial needs

A priority Nursing Diagnosis is NOT the same thing as a priority intervention. You are stuck on cleaning the patient up, that is a task that is basic nursing skills. You are going to write in a care plan one day that keeping the patient clean and dry is something I can do independently to help prevent worsening of my patients wound, promote healing as well as maintain patient dignity.

allinoneplace01 · Jul 24, 2015

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

allinoneplace01 · Jul 30, 2015

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.

BeachsideRN, ASN · Jul 30, 2015

I really wanna know where OP goes to school

MendedHeart · Jul 30, 2015

I really wanna know where OP goes to school

Me too. Just goes to show PhD means nothing.

Tex. · Jul 30, 2015

Now, she did say that some hospitals may follow Maslow guidelines, but according to my location they follow Nanda.

Wait, what? NANDA should align with Maslow.

Tex. · Jul 30, 2015

I am beating a dead horse, I know, but...

#3 does not hold up. Compromised human dignity AEB soiled underpants x2. If patient has urge incontinence (#2), then this is not evidence of anything but urge incontinence.

Jensmom7, BSN, RN · Jul 30, 2015

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?

Ok, you're a student, so a little instruction here:

1. The only wounds that are staged are pressure wounds.

2. Pressure wounds occur over bony prominences.

3. An inguinal wound caused by friction, that's an abrasion, pretty much a rug burn type of injury. If there's little drainage, a barrier cream with zinc oxide will heal it very quickly.

4. A true Stage I pressure wound presents with reddened, intact skin, over bone, non-blanchable, and the redness does not resolve when the affected area is offloaded for at least 15-20 minutes. If it blanches and resolves, not a Stage I but still needs to be watched as it is definitely at risk for breakdown.

I know this isn't really what you were asking about, but you were already given some good advice by some very knowledgable Nurses, so I thought I would use the opportunity to pass along things I've learned as a Wound Geek in a past life.