NSG 123 Unit 1 problem ranking write-up example

Five Problems on Admission, Ranked and Defended: A 58-Year-Old Dispatcher With Diverticulitis and a Small Abscess Beside the Colon

Student Name

Department of Nursing, Herzing University

NSG 123: Medical-Surgical Nursing I

Instructor Name

January 16, 2026

Five Problems on Admission, Ranked and Defended: A 58-Year-Old Dispatcher With Diverticulitis and a Small Abscess Beside the Colon

The Patient as the Case Supplies Her

A composite 58-year-old woman who works nights as a county emergency dispatcher is admitted from the emergency department with four days of worsening pain in the left lower abdomen. A CT scan shows inflammation of the sigmoid colon with a 4 cm collection of pus beside it, a pericolic abscess. On arrival to the floor: temperature 38.6 °C, heart rate 108, blood pressure 118/72, respiratory rate 20, oxygen saturation 97% on room air. Pain 8 of 10, worse with movement; she lies still with her knees drawn up. Nauseated, vomited twice today, has eaten almost nothing for two days. White cell count 16,800. Potassium 3.2 mmol/L. Orders include nothing by mouth, intravenous fluids and antibiotics, and consultation with interventional radiology about draining the abscess. She takes lisinopril for blood pressure and ibuprofen for back pain. She says, "I can't be off work long. We're short-staffed."

The Problems, in the Order the Case Presents Them

Acute pain. Infection, with a localized abscess and a systemic response. Fluid volume deficit from vomiting and poor intake. Low potassium. Anxiety about work. Risk from ibuprofen use (listed here because it appears in the case; it is a medication question to raise, not a nursing problem to rank).

The Framework

The ranking uses the physiological threats first, then safety, then psychosocial, and within the physiological level asks which problem could harm her soonest if nothing were done (Hinkle et al., 2022). A problem that causes others ranks above the problems it causes.

The Ranked Sequence

1. Infection with a systemic response. The finding that raises it now: fever of 38.6 °C, heart rate 108, and a white count of 16,800, with a known abscess. Together these show that her body is reacting to the infection beyond the colon. It outranks fluid deficit because the infection is the source of the fever and part of the reason she is not eating; untreated, a pericolic abscess can progress or rupture, which is the complication guidelines for complicated diverticulitis are written around (Hall et al., 2020). Nursing's part is making sure antibiotics start on time, watching for the signs of spreading infection, and preparing her for drainage.

2. Fluid volume deficit. Finding: two episodes of vomiting, two days of minimal intake, a heart rate of 108 that fever alone may not explain, and her lisinopril, which can blunt her body's response to low volume. It ranks below infection because it is partly caused by it, and above pain because a fall in blood pressure would be a more immediate threat than pain. It is also the problem whose improvement nursing can measure most directly.

3. Low potassium. Finding: 3.2 mmol/L after vomiting. It could have been placed with the fluid deficit, since the cause is the same, but it has its own risk: low potassium can disturb heart rhythm and slow the bowel. It ranks third rather than second because at this level it is mild and replacement is already ordered, while the fluid problem affects her circulation now.

4. Acute pain. Finding: 8 of 10, guarding, lying still with knees drawn up. Pain matters a great deal to her, and it limits deep breathing and moving. It ranks fourth not because it is less real, but because treating the infection is what will reduce it, and because a sudden change in her pain is one of the key signs that the abscess is worsening, so it is also a monitoring point for problem 1.

5. Anxiety about work. Finding: her statement about being short-staffed and needing to return. It is last on the physiological-first framework, but it has a practical consequence: a patient worried about leaving may underreport pain or push for early discharge, which feeds back into problem 1.

What Would Change the Order

A sudden increase in pain spreading across the whole abdomen, a rigid abdomen, or a fall in blood pressure would suggest the abscess has ruptured. That would put infection at the top with new urgency and move pain from a comfort problem to a sign requiring immediate report. A potassium below 3.0, or new palpitations, would move potassium above fluid. If the fever and heart rate settle after antibiotics and drainage, fluid and pain would become the leading nursing problems.

The ibuprofen is not ranked, but it is reported: nonsteroidal anti-inflammatory drugs are linked to diverticulitis and its complications, and expert guidance advises patients with a history of diverticulitis to avoid them apart from aspirin prescribed for heart protection (Peery et al., 2021). The patient is a composite.

References

Hall, J., Hardiman, K., Lee, S., Lightner, A., Stocchi, L., Paquette, I. M., Steele, S. R., Feingold, D. L., & Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. (2020). The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Diseases of the Colon & Rectum, 63(6), 728-747. https://doi.org/10.1097/DCR.0000000000001679

Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.

Peery, A. F., Shaukat, A., & Strate, L. L. (2021). AGA clinical practice update on medical management of colonic diverticulitis: Expert review. Gastroenterology, 160(3), 906-911. https://doi.org/10.1053/j.gastro.2020.09.059