IX.

Problem Prioritization Nursing Diagnosis Ineffective airway clearance related to Copious tracheobronchial secretions and ineffective cough as manifested by abnormal breath sounds,shortness of breath and dyspnea Rank 1 Justification This was given the highest priority because it is an actual problem that requires immediate action. It is easily modifiable because the resources are available to the client and the nurse. Maintaining a patent airway is vital to life thus I must be prioritized first. This problem is the second priority because it is an actual problem that needs to be solved. Pain from post operative site also contributes to ineffective cough thus this should require immediate action. It is easily modifiable because the resources are available to the client and the nurse. This problem is the third priority because it is an actual problem however referring to ABC before focusing to circulation Airway and oxygenation should be met first. This problem is the fourth because lifestyle and behavior should be modified first so that the below problem can be met.

Acute pain related to post operative site as manifested by patient reports of pain, facial grimace and guarding behavior

Ineffective Tissue Perfusion related to decreased hemoglobin concentration in blood as manifested by signs and symptoms of dyspnea, pale conjuctive and nail beds tachypnea Ineffective health maintenance related to adverse personal habits as manifested by frequent respiratory infection, anemia and poor hygiene

Imbalance Nutrition: Less than body requirement related to insufficient intake of nutritious food due as manifested by thin and weak appearance and body mass index of 12.5 Activity Intolerance related to imbalance between oxygen supply/demand as manifested

This problem is the fifth priority because it is an actual problem and categorized in physical needs according to Maslows. This problem is the sixth priority because before referring to Maslows hierarchy

by weakness, fatigue, change in vital signs and dypnea

of needs Airway Breathing Circulation (ABC) ahould be met first.