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PRIORITIZED LIST OF NURSING PROBLEMS NURSING PROBLEMS IDENTIFIED Wandering related to over stimulating evironment CUES I > stated by the teacher, “Mahilig siyang maglakad at magtatatakbo.” > stated by the teacher, “Kapag pinaupo siya sa harapan, 2-5 minutes, balik nanaman siya sa dati. Tatakbo nanaman siya sa likod at maglalakad-lakad ulit.” > stated by the father, “May pagka-hyper, malikot at hindi matigil sa isang lugar.” O > frequent movement from place to place > often revisiting the same destination > persistent locomotion in search for something (e.g. ball) > locomotion cannot be easily dissuaded > shadowing a caregiver‟s locomotion > hyperactivity Risk for Injury I > stated by the teacher, “Mahilig siyang maglakad at magtatatakbo.” > stated by the father, “May pagka-hyper, malikot at hindi matigil sa isang lugar.” “Sa tingin ko normal naman yon sa mga bata sa edad niya „di ba? Kasi pag kasama niya mga pinsan niya lahat sila magugulo naman.” O > restless > runs about and climbs excessively > often “on-the-go”; often acts as if “drive by a motor” O > failure to recognize 1out of 3 colors > failure to differentiate hot from cold > failure to differentiate black from white MEDIUM PRIORITY This is a medium priority problem since it is a safety and security need according to Maslow‟s hierarchy of needs. It is urgent as well as important but it is not a lifethreatening problem. RANK HIGH PRIORITY JUSTIFICATION This is a high priority problem because it is existing. This also falls on the safety and security need on Maslow‟s hierarchy of needs. It is also observed by at least one caregiver and is given intervention. The secondary caregiver sees this as a problem and wants immediate attention.

Risk for Delayed Development

MEDIUM PRIORITY

This is a medium priority problem since it is a safety and security need according to Maslow‟s hierarchy of needs. It is urgent as well as important but it is not a lifethreatening problem. Also, one of the parents does not recognize it as a problem. This is a low priority problem since it belongs to the love and belongingness need in Maslow‟s hierarchy of needs.

Risk for Impaired Parenting

I > stated by the father, “Hindi ako natutulog doon. Pag gabi, tita at lola lang niya kasama niya. Nakikita ko lang siya

LOW PRIORITY

ako din sa iba. .” “ Yung nanay niya sa ibang bahay nakatira.pag umaga. such as full parent participation is not immediately available.” It is urgent as well as important but it is not a lifethreatening problem. tapos pag hapon na sunduin ko siya. Resources. hated ko siya sa school.