Problem Identification and Prioritization
Table 8. Prioritized Nursing Problems
NURSING CUES
DIAGNOSIS
Imbalanced nutrition: Subjective Cues:
less than body “May oras na minsan wala
requirements related to akong ganang kumain, at ang
dietary restrictions daming hindi ko na pwedeng
kainin. (I have a lot of food
restrictions and oftentimes I
experience loss of appetite)”
as verbalized by the client.
Objective Cues:
 Anemia (Hgb: 98 g/L)
 Fatigue
 Poor Muscle tone
 Initial weight upon
entry into dialysis
unit: 57.5kg
 Present weight 51-
54kg
 BMI: 19.9
(underweight)
Fluid Volume , excess Subjective Cues:
related to “Alam ko na may limit ako sa
Compromised pag-inom ng tubig pero
Regulatory minsan napaparami ang inom
Mechanisms (Chronic ko ng tubig lalo na pag mainit
Kidney Disease) ang panahon. (I know that I
have fluid intake limitations
but sometimes I tend to drink
a lot most especially during a
hot weather)” as verbalized
by the client.
Objective Cues:
JUSTIFICATION
Ranks first among the
nursing problems identified
since it affects the
physiological needs of the
client according to Maslow’s
Hierarchy of needs. Due
restriction of some food, an
individual experiencing renal
problem cannot maintain
ideal body weight and
sufficient nutrition. At the
same time patients may
experience anemia due to
decrease erythropoietic
factor that cause decrease in
production of RBC causing
anemia and fatigue.
Ranks second among the
nursing problems identified
since it affects the
physiological needs of the
client according to Maslow’s
Hierarchy of needs. Fluid
accumulation is a hallmark
in renal patients on
hemodialysis. It can cause
serious complications in
patients with CRF, such as
acute pulmonary edema,
circulatory overload with
consequent decrease in the
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  Oliguria
 Mild bipedal edema
 Fluid intake 2-2.5
liters per day.
 BP changes: elevated
BP especially pre HD
(180/100 mmhg)
Impaired physical Subjective Cues:
mobility related to pain “Minsan nahihirapan talaga
on both knees akong gumalaw lalo na pag
masakit ang mga tuhud ko.
(Sometimes I have difficulty
in doing physical activities
because my knees are in
pain)” as verbalized by the
client.
Objective Cues:
 Increased pulse
 Elevated blood uric
acid
 Mild swelling of both
knees
 Barthel Index of ADL
score: 75/100
(moderate
dependency)
Fatigue related to Subjective Cues:
anemia and dialysis “Lagi akong pagod.
procedure Nararamdaman ko rin ito
pagkatapos ng dialysis ko.
efficiency of the heart,
leading to congestive heart
failure and hypertension. The
latter is the main risk factor
for developing coronary
artery disease,
cerebrovascular disease and
pulmonary congestion.
Thus, if these complications
are not treated quickly, they
can further aggravate the
health status of patients or
even trigger death, being
rapid accurate diagnosis of
fluid volume excess by
nurses, fundamental, in order
to prevent or minimize the
aforementioned
complications.
(Sacks and Campos, 2010)
Ranks third among the
nursing problems identified
since it affects the
physiologic needs of the
client according to Maslow’s
Hierarchy of needs. A
modification in movement or
mobility can either be a
transient, recurring or more
permanent dilemma. And
when it occurs, it becomes a
complex health care problem
that involves many different
members of the health care
team.
(nurseslabs.com/impaired-
physical-mobility)
Ranks fourth among the
nursing problems identified
since it affects the
physiologic needs of the
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 Wala akong lakas, minsan
gusto ko ng matulog at
magpahinga. (I get tired
easily. I ‘am feeling weak
after every dialysis session. I
just feel like I just want to
rest) ” as verbalized by the
client.
Objective Cues:
 Anemia (Hgb: 98 g/L)
 Falls asleep
immediately after
cannulation for
hemodialysis
treatment
 Fatigue Severity Scale
score: 46 ( suffering
fatigue)
Disturbed sleep pattern Subjective Cues:
related to unresolved “Nahihirapan akong matulog,
psychological conflict kasi minsan naiisip ko ang
sakit ko, lalo na’t bata pa ang
mga anak ko. (I ‘am
experiencing trouble in
sleeping, maybe because I
‘am worried about my illness
and how it’s affecting my
family)” as verbalized by the
client.
Objective Cues:
 Frequent yawning
 Fatigue
 Often sleeps late at
night
 Average sleeping time
4-5 hours
 Insomnia Severity
Index score: 14/28
(Subthreshold
insomnia)
client according to Maslow’s
Hierarchy of needs. People
with CKD are more prone to
fatigue and weakness often
cause by anemia. Damaged
or already failed kidneys
cannot circulate oxygen and
filter waste out of the blood.
Fatigue is also common
complain among patients on
dialysis. This is because
dialysis machine that
replaces parts of loss kidney
functions including
discharging metabolic
wastes, excessive water and
electrolytes from the blood
and balancing water,
electrolytes and acid-base.
(www.kidney-cares.org)
Ranks last among the
nursing problems identified
since it affects the
physiologic needs of the
client according to Maslow’s
Hierarchy of needs. Sleep is
required to provide energy
for physical and mental
activities. The amount of
sleep that individuals require
varies with age and personal
characteristics. Disruption in
the individual’s usual diurnal
pattern of sleep and
wakefulness may be
temporary or chronic.
Addressing sleep pattern
disturbance will reduce both
subjective distress and
apparent impairment in
functional abilities.
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