What is the priority?

[Tampa Nurse]

Hi everyone!

I've been lurking here for a while and really enjoy this community. I've come out of the shadows in need of help! :wink2:

I'm writing my last care plan for the semester and we have to have all potential nursing diagnoses for out patient in order of priority. I've read the sticky thread on care plans but i'm still confused!

Should "Risk for" diagnoses be listed last? I thought I read this somehwere but can't remember where.

My patient is a 75 year old female with a new diagnoses of Myasthenia Gravis with history of: hypertension, hyperlipidemia, MI, CAD, and DM type 2.

Here is my list so far. Any recommendations on ordering? After I prioritize I have to write three complete care plans. yay!

1. Activity Intolerance related to muscle weakness and fatigability.

2. Imbalanced nutrition: more than body requirements related to intake in excess of activity expenditure as evidenced by a

BMI of 25.2.

3. Constipation related to inadequate fluid intake and low fiber diet as evidenced by patient report of straining at stools.

4. Disturbed body image related to inability to maintain usual lifestyle and role responsibilities.

5. Disturbed sensory (visual) perception related to ptosis as evidenced by double vision.

6. Fear related to anticipation of disease process as evidenced by patient report of fearful feelings.

7. Compromised family coping related to overwhelming situation as evidenced by tearful visit from patient’s daughter.

8. Deficient knowledge related to diagnosis of new condition as evidenced by numerous questions about new diagnosis.

9. Risk for aspiration related to impaired swallowing secondary to disease process.

10. Risk for injury related to decreased tactile sensation.

11. Risk for falls related to visual difficulties, unfamiliar, dimly lit room, and impaired physical mobility.

12. Risk for peripheral neurovascular dysfunction related to vascular effects of diabetes.

Thank you in advance for any help or suggestions!

Brooke

[ChristineN, BSN, RN]

Well, while not the priority, I would think with a new diagnosis of anything pt teaching would be near the top of the list, so Knowledge Deficit.

[SuesquatchRN, BSN, RN]

It is ALWAYS according to Maslow's Hierarchy of needs - so safety before anything else. And within that, ABC's - airway, breathing, circulation.

Her risk for aspiration strikes me as being of immediate concern - airway.

Impaired physical mobility is not an a/e/b, it's a NANDA diagnosis and is very important.

Risk for falls is very important.

Disturbed body image doesn't relate to weakness and a problem with ADL's. Nothing that you have supports that.

A BMI of 25.2 as a justification for imb nut - more than body reqs is something I'd leave out, unless your instructor will ding you on it.

Constipation is also important as straining can lead to a vasovagal episode of syncope - fainting.

The disturned sensory perception is quite important as it places her at increased risk for injury.

SAFETY. AIRWAY.

The teaching and stuff is never as important as keeping your patient safe and breathing.

:)

[Daytonite, BSN, RN]

"risk for" diagnoses are anticipated problems that do not exist yet. they take last priority compared to actual problems. unless you were given some other system by which to prioritize, the maslow hierarchy of needs is a good system to use in classifying priorities (http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs):

1. activity intolerance related to muscle weakness and fatigability. (physiological need for oxygen)
   
2. imbalanced nutrition: more than body requirements related to intake in excess of activity expenditure as evidenced by a bmi of 25.2. (physiological need for food)
   
3. constipation related to inadequate fluid intake and low fiber diet as evidenced by patient report of straining at stools. (physiological need for elimination)
   
4. disturbed sensory (visual) perception related to ptosis as evidenced by double vision. (physiological need for movement)
   
5. deficient knowledge related to diagnosis of new condition as evidenced by numerous questions about new diagnosis. (need for safety from physiological threat)
   • you must specify and name the deficiency as part of the title of the nursing diagnosis: deficient knowledge, myasthenia gravis

[*]fear related to anticipation of disease process as evidenced by patient report of fearful feelings. (need for safety from psychological threat)

[*]disturbed body image related to inability to maintain usual lifestyle and role responsibilities. (need for self-esteem)

• this related factor doesn't sound right; it doesn't sound like what has triggered the patient to start having problems with the way they visualize their body. it sounds like what has happened as a result of body changes. the related factors for this diagnosis are things like hair loss when people have had chemotherapy, facial scaring as a result of an accident, a woman with excessive hair on the face from hormonal imbalances or someone who feels odd having to walk around with a halo on due to a neck fracture.

[*]compromised family coping related to overwhelming situation as evidenced by tearful visit from patient's daughter. (need for love and belonging)

[*]risk for peripheral neurovascular dysfunction related to vascular effects of diabetes. (anticipated physiological need for oxygen)

• i don't think your instructor is likely to let you get away with using a medical diagnosis as a risk factor for a disruption in this patients circulation, sensation or movement. we already know that these things are a complication of diabetes and you are just trying to say it with a nursing diagnosis. if i saw it, your instructor is likely to see it too. you have to state what potential activity you think might push the patient's already precariously lousy neurovascular situation over the edge: being immobile? a bump on the leg? ted hose being left on too long? state it as the risk factor, i.e. risk for peripheral neurovascular dysfunction related to strict bed rest.

[*]risk for aspiration related to impaired swallowing secondary to disease process. (anticipated physiological need for food)

• when you say "secondary to" actually name the medical disease, i,e, risk for aspiration related to impaired swallowing secondary to myasthenia gravis.

[*]risk for injury related to decreased tactile sensation. (anticipated physiological need for safety)

[*]risk for falls related to visual difficulties, unfamiliar, dimly lit room, and impaired physical mobility. (anticipated physiological need for safety/protection)

• i thought the patient had double vision? unfamiliar with what? you need to be more specific in describing that. what is a dimly lit room?

[Tampa Nurse]

Thank you so much Daytonite! I'm going back and rewording. Your help is very much appreciated! :)

Brooke