PROBLEM PRIORITIZATION Nursing Problems Identified Acute pain related to actual tissue damage as manifested by verbal report of pain

and observed evidenced of pain Cues Subjective: Ramdam ko pa rin na sumasakit yung part kung saan ako naoperahan, masakit pa rin talaga as verbalized by the client Rank 1 Justification
The nature of the problem is high because it is health threatening. It belongs to the physiologic needs in Maslows Hierarchy of Needs. It is considered as an actual problem and needs an immediate attention and intervention as possible because it has a big impact to the lifestyle and health of the patient because it also greatly affects the physical activities and sleep pattern of the patient compared to the other nursing problems. In terms of the resources, both the client and the nurse have the resources.

Objective: -When the patient was asked to rate the pain that he feels from the rate from 1 to 10, 10 being the highest. The patient rate the pain as 7.

-Verbal report of pain

-Observed evidenced of pain

-Facial Grimace

Sleep deprivation related to uncomfortable sleep environment as manifested by daytime drowsiness, restlessness and slowed reaction

Subjective: Hindi ako nakakatulog ng maayos kasi andito ako sa hospital, nahihirapan ako matulog kasi hindi ako sanay as verbalized by the client.

Objective: -Observed presence of eyebags -Drowsiness -Slowed reaction -restlessness Constipation related to irregular defecation pattern as manifested by change in bowel pattern Subjective: Apat na araw na ako hindi dumudumi, dati naman halos arawaraw ako dumudumi as verbalized by the client. 3

The nature of the problem is medium because it is health threatening but is less prioritized than the first problem. It belongs to the physiologic needs in Maslows Hierarchy of Needs. It is considered as an actual problem. In terms of the resources, both the client and the nurse have the resources.

-Hindi pa ako umiinom ng tubig dalawang araw na

The nature of the problem is medium because it is health threatening but is less prioritized than the second problem. It belongs to the physiologic needs in Maslows Hierarchy of Needs. It is considered as an actual problem. In terms of the resources, both the client and the nurse have the resources. The nature of the problem is low

Risk for Infection related to Invasive

Subjective:

procedure

Katatapos ko lang operahan sa appendix

because it only requires minimal nursing support. It is considered as a potential factor. In terms of the resources, both the client and the nurse have the resources.

Risk for deficient fluid volume related to deviation affecting intake of fluids

Subjective: Dalawang araw na akong bawal uminom ng tubig, tapos kanina lang ako pinayagan uminom as verbalized by the client.

The nature of the problem is low because it only requires minimal nursing support. It is considered as a potential factor. In terms of the resources, both the client and the nurse have the resources.