What order for priority of nursing dx?

ImThatGuy, BSN, RN · Mar 19, 2011

I think the order you typed them is good. You might swap the two risk fors.

solneeshka, BSN, RN · Mar 20, 2011

You need to balance what poses the greatest degree of risk to the patient with what is most likely to occur with the patient. In my nursing school, we were beat over the head with "pain never killed anybody." In other words, dealing with pain is important but it will almost never be your top nursing diagnosis. Any significant possibility of infection is going to be very, very high on the list. If you get through ABC and nothing clicks yet, then go to infection because any infection can enter the bloodstream and then you have a potential fatality on your hands. With appendicitis, risk for infection is absolutely your #1 nursing diagnosis because that's the problem with appendicitis: the appendix may blow and if it does, you have a very short amount of time to get inside the OR and clear things out before sepsis will set in. A burst appendix is blowing fecal matter all over the peritoneum, very very bad. I would put pain next, because appendicitis pain really is awful. After that, I like your risk for constipation because of the pain meds. Risk for impaired nutrition I'm not so worried about because it will be pretty short term and most people can deal with not eating for a couple of days under such circumstances without affection their general nutrition level. Dehydration is going to be your bigger concern, I would change out the nutrition for dehydration. Impaired skin integrity I don't really get unless the patient is having an appendectomy also (I assume so but it's not stated). You've thought of some really good concerns!

pinkraven · Mar 20, 2011

solneeshka - Thank you so much! What you wrote really helped me understand better how to prioritize diagnosis. And yes, I for got to mention the patient did have appendectomy. Thanks again!

valsalvamanuever2 · Mar 21, 2011

At my school (my only frame of reference), aside from ABC's, prioritization is normally based off of specifics of the pt. (how off is nutrition ((BMI/albumin?)), how old is pt.?, etc. My instructors also seem to want to varying degrees to first prioritize something which influences something further down the line (for example as nutrition affects wound healing and immune system function). I often feel that it comes to a flip of the coin once the obvious are listed. For this pt. I may focus somewhat more on risk for infection (both related to an abdominal surgery as well as respiratory risk due to immobilization ((dependent somewhat on age/activity level/physical fitness).

Hope this doesn't confuse things more.