Trying to decide which diagnosis is more appropriate?

[StudentNurzNK]

I just started nursing school this fall, and have a patient I am making a care plan for. I missed my clinical day and need to make up for it with a good grade! I am having a hard time deciding what the best diagnosis would be between Periferal Neurovascular Dysfunction, and Altered Tissue Perfusion...or any other diagnosis you can come up with that would be a high priority? Here's the info:

Pt admission dx is altered mental status and dementia secondary to multiple CVAs & UTI in context of vascular dementia.

His past hx is dysphagia, low vision, orbital fracture, pulmonary embolism infarct, Trans ischemic attack, Sclerosis of aortic valve , A-fib, CHF, CAV, Intermittent Claudication.

Phys exam: HEENT- EOMI, MMM; Cardio- RRR, no m.g.r; Resp- CTA bilat; GI- +BS, NT and ND. Braden score of 15. Record never stated diabeties, but he is prescribed insulin novalin R reserved for gluc.

He is having auditory and somewhat visual hallucenations. He stabbed an employee with a fork, and twisted a frail lady's arm because he thought she had a gun up her sleve. He is depressed with diff. sleeping, decreased energy, poor concentration, decreased memory and sometimes disoriented completely. Shows poor judgement and insight. His ordered diet is pureed for dysphagia, but notwhere in his current health status does it mention problems swallowing, which makes me not want to use that as a diagnosis (lack of facts) even though that would be higher priority.

I needed one psychosocial and one physiological, and I have:

*Disterbed thought process r/t organic mental disorder aeb visual and auditory hallucenations , impared memory and judgement.

I am having trouble coming up with related to factors of Risk for peripheral neurovascular dysfunction. What about r/t sclerotic aortic valve?

[Daytonite, BSN, RN]

For psychosocial I'd use Risk for Other-Directed Violence R/T history of violence against others, neurological impairment, hallucinations and impaired thought processes.