A patient with a newly diagnosed rheumatic disease reports significant joint pain and stiffness, making it difficult to perform daily activities. Which nursing diagnosis should the nurse prioritize?

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

The patient's chief complaints are significant joint pain and stiffness, which are physiological problems that directly limit movement.
This diagnosis correctly identifies the primary problem (impaired mobility) and its direct cause (decreased range of motion and pain), as stated in the clinical scenario.
According to prioritization frameworks like Maslow's Hierarchy, physiological needs such as mobility and comfort (pain relief) must be addressed before psychosocial needs.
Addressing the root cause of impaired mobility is the most effective way to help the patient regain the ability to perform daily activities.

Option A: This is a psychosocial diagnosis. While a patient with a chronic illness may experience body image disturbances, it is not the immediate priority compared to a significant physiological problem like pain and immobility.
Option C: This is a psychosocial diagnosis. While a new diagnosis can cause stress and require coping strategies, the immediate priority is managing the physical symptoms that are causing functional impairment and distress.
Option D: Self-care deficit is a consequence of the impaired physical mobility, not the primary problem itself. The inability to perform self-care is due to the pain and stiffness. By treating the mobility issue, the self-care deficit will likely improve.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Prioritization of Nursing Diagnoses in acute care settings.
In nursing practice, correctly prioritizing diagnoses is crucial for effective care planning. Using frameworks like Maslow's Hierarchy of Needs helps nurses address the most life-impacting problems first.
For patients with rheumatic diseases, the nursing focus is often on pain management, preserving joint function, and maintaining independence. Interventions for impaired mobility include administering analgesics, teaching about joint protection, and encouraging range-of-motion exercises.
What if? - If the patient had stated, 'I can move my joints, but I'm so exhausted and sad about this diagnosis that I don't have the energy to even wash my face,' then 'Self-care deficit related to fatigue and ineffective coping' would become a much higher priority diagnosis.

How to Approach the Question

First, identify the question type. This is a clinical scenario that asks you to prioritize a nursing diagnosis.
Next, carefully read the stem and identify the key patient data. The patient reports 'significant joint pain and stiffness' that makes 'daily activities difficult'.
Apply a prioritization framework. Maslow's Hierarchy of Needs is a common tool, which places physiological needs (like safety, comfort from pain, mobility) before psychosocial needs (like self-esteem, coping).
Evaluate each option. Ask yourself: Does this diagnosis address the root cause of the patient's problem, or is it a consequence of another problem?
Option B, 'Impaired physical mobility,' directly addresses the physiological impact of the patient's reported pain and stiffness.
Options A and C are psychosocial. Option D is a consequence of the mobility issue. Therefore, the physiological, root-cause diagnosis is the priority.

Concept Tested & Keywords

Concept Tested: Prioritization of Nursing Diagnoses
Stem keywords: rheumatic disease, joint pain, stiffness, daily activities
Lead-in keywords: prioritize
Clinical cues: The patient's report of 'significant joint pain and stiffness' is the key clinical cue, pointing directly to a physiological problem with movement.

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E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 144-146

Practise the full SCTIMST Staff Nurse - 2015 (Set-A)

Attempt every question from this paper in a timed mock, then review the full solution for each one.