Which nursing diagnosis is most important?

jnick31 · Jan 23, 2011

I would start with the ABC's then go to Maslow. :) good luck.

myty23 · Jan 23, 2011

He was in fluid overload. Did he have pulmonary edema from the fluid overload? You said he was short of breath, was this related to the fluid overload also? I'd say probably something with airway/breathing:

Ineffective breathing pattern; impaired gas exchange then go onto circulation:

ineffective tissue perfusion; decreased cardiac output

ImThatGuy, BSN, RN · Jan 23, 2011

Cardiac trumps renal. It's basic ABC's.

ejm99 · Jan 23, 2011

I agree... ABC's then SAFETY.

myty23 · Jan 23, 2011

Cardiac trumps renal. It's basic ABC's.

Yes, but airway/breathing trumps circulation....I'm surprised the OP didn't even address the shortness of breath at all. It doesn't really seem that she has put all the pieces together. No offense intended to the OP, maybe she is in first semester?

ImThatGuy, BSN, RN · Jan 23, 2011

Yes, but airway/breathing trumps circulation....I'm surprised the OP didn't even address the shortness of breath at all. It doesn't really seem that she has put all the pieces together. No offense intended to the OP, maybe she is in first semester?

I didn't mention A or B because her only option was C and renal, lol. Maybe the OP has to pick one or the other. Who knows? That's why I didn't elaborate further.

myty23 · Jan 23, 2011

I didn't mention A or B because her only option was C and renal, lol. Maybe the OP has to pick one or the other. Who knows? That's why I didn't elaborate further.

Maybe your right. In that case, yes definitely the cardiac output would be priority.

ImThatGuy, BSN, RN · Jan 23, 2011

I agree... ABC's then SAFETY.

Other way around. YOUR safety, then their ABC's, lol.

Scene safe.

BSI.

ABC's.

MunoRN, RN · Jan 24, 2011

I'm not sure why nursing school teachers use the ABC's in this situation (mine did too), but the ABC's don't really apply in this situation. The ABC's (which are now the CAB's) are meant for when you lack an airway, breathing, or circulation. As long as each of these exist, your priority should be to protect each of these by prioritizing based on the acuity of the threat, not the system threatened.

In this case it's really all the same intertwined problem made up of individual problems where each worsens each other in a continuous loop. The decreased cardiac output due to the cardiomyopathy causes pre-renal failure which causes fluid overload which causes both increased after load which worsens Left sided heart failure; and pulmonary edema which causes increased PA pressures which worsens Right sided failure, maintaining a continuous loop of badness.

This means there are multiple priorities here. Assuming the cardiomypathy and renal failure are essentially unchanged from their normal chronic state, the acute problem here, which is pulmonary edema (impaired airway at the level of the alveoli), should be first on the list for treatment in the form of a diuretic and possible morphine as well in the case of flash pulmonary edema. If the cardiomyopathy is in an acute state of failure (cardiogenic shock) then diuretics will also help, and other methods of optimizing cardiac output would also be considered. If the patient is in an acute state of renal failure, diuretics may not work and may require dialysis or CRRT. Overall, the root cause may well be the cardiomyopathy making this the long term priority.

This is what I hate about Nursing Diagnoses. Even more than MD's, it's important the nurses understand how various problems intertwine, and using a structure for thinking such as Nursing Diagnoses which uses a piecemeal approach rather than a holistic approach is something that nurses must unlearn at some point to progress.

Sorry about the rant, hope this helps.

ImThatGuy, BSN, RN · Jan 24, 2011

ABCs were meant for all. Most patients inherently have a patent airway, adequate breathing, and circilation that supports life so you skip over it mentally. I think it applies to the scenario in question though. I didn't realize nursing school taught ABCs. I don't recall any of my faculty saying it. I picked it up in EMT school prior to paramedic school prior to BSN school.

I hate nursing diagnoses as well. Why not call the problem what it is and treat it accordingly? Treating the response is silly. Treat the problem and associated manifestations and be done with it.

MunoRN, RN · Jan 28, 2011

ABCs were meant for all. Most patients inherently have a patent airway, adequate breathing, and circilation that supports life so you skip over it mentally. I think it applies to the scenario in question though. I didn't realize nursing school taught ABCs. I don't recall any of my faculty saying it. I picked it up in EMT school prior to paramedic school prior to BSN school.
I hate nursing diagnoses as well. Why not call the problem what it is and treat it accordingly? Treating the response is silly. Treat the problem and associated manifestations and be done with it.

The ABC's are important for everybody, but as a way of prioritizing tasks they are only applicable to a patient in cardiac/respiratory arrest. Otherwise you have to consider other factors in prioritizing your care. A chest cold technically results in a compromise airway. If the patient goes into sustained VT should I wait to treat it until after I have addressed the chest cold?

Nursing schools should go into the ABC's (CAB's) when they cover code situations, and most nursing schools require a BLS class as well.

Long ago, Nursing was defined as those who "treat the response to disease" while Doctors treat the cause of disease, making it sound as though Nursing is purely reactive while Doctors are the only ones acting proactively in caring for a patient's health. This is an outdated and out of touch definition that every nursing organization in the world has abandoned, except for the ANA, which isn't that surprising since they themselves are outdated and out of touch.