Prioritizing list of diagnoses

  1. I a working on my first care plan of the semester and have a nice list compiled of all of the actual and "risk for" diagnoses for my client. Now I need to prioritize them and I'm stumped.
    I have "risk for" diagnoses for physciological needs and higher needs. My question is this: are the lower, physiological "risk for" diagnoses higher in priority than theactual higher level dagnoses (i.e. love and belonging needs), or do all of the "risk for" diagnoses come after all of the actual (both lower and higher need) diagnoses?
    Am I making any sense?
    Thanks for any input!
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  2. 18 Comments

  3. by   jamonit
    risk for infection or risk for injury would be prioritized. disturbed energy fields (haha), anxiety, self care deficit would be less important. think maslows.
  4. by   jamonit
    most potentials, such as risk for constipation would be after the other actual diagnoses. but i always learned risk for injury and infection tend to be higher prioritzed.

    does that make sense?
  5. by   missninaRN
    So would a risk for constipation come after an actual diagnosis of impaired family functioning, for example?
  6. by   Daytonite
    This is a very good question.

    You prioritize your anticipated nursing diagnoses just like you do your actual diagnoses. Ignore the "Risk for" part for the moment. These anticipated problems can all be classified to such things as physiological, safety and security, love and belonging, self-esteem and self-actualization needs just like all other nursing diagnoses. You know the priority sequence of those, don't you? These sequence the same way. Once you have them prioritized in the proper order you can now add ALL the "Risk for" diagnoses to the end of the ALL your actual nursing diagnoses you have for your patient.

    Hope this un-stumps you.
  7. by   jamonit
    Quote from missnina
    So would a risk for constipation come after an actual diagnosis of impaired family functioning, for example?

    impaired family functioning is before risk for constipation.

    pain, risk for infection, impaired family coping, powerlessness, etc. would be for risk for constipation and risk for impaired family coping. see, it's hard to explain, but i think of it like risk for infection could kill--risk for injury (like volume overload) could cause CHF. I used to order my diagnoses by risk for infection, pain, (physio stuff) then psychosocial, then i would do the potential (but less threatening stuff like risk for infection or risk for impaired mobility). it's hard to expain without talking it out, but that's how i did it. what are your nursing diagnoses and i'll help you arrange them...or tell me the med diagnoses and i'll help you come up with the order.

    hope that helps!
  8. by   Daytonite
    Quote from missnina
    So would a risk for constipation come after an actual diagnosis of impaired family functioning, for example?
    Yes. All actual existing problems must be sequenced first. Risk for constipation is not a real problem, but an anticipated one. Therefore, it takes lowest priority and goes to the end of the line.

    If you had, for example, both:
    1. Risk for constipation (physiological need), and
    2. Risk for Impaired Family Functioning (love and belonging need)
    they would be sequenced as I have them because constipation is classified as a physiological need and impaired family functioning is classified as a love and belonging need. On Maslow's Hierarchy of Needs, physiological needs take priority over love and belonging needs.
  9. by   Daytonite
    Quote from jamonit
    i think of it like risk for infection could kill--risk for injury (like volume overload) could cause chf. i used to order my diagnoses by risk for infection, pain, (physio stuff) then psychosocial, then i would do the potential (but less threatening stuff like risk for infection or risk for impaired mobility). it's hard to expain without talking it out, but that's how i did it. what are your nursing diagnoses and i'll help you arrange them...or tell me the med diagnoses and i'll help you come up with the order.
    maslow is very clear on how to sequence! it has nothing to do with medical diagnoses!

    http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

    within the tier of physiological needs the sequence from top priority to the bottom is as follows:
    1. oxygenation needs (this includes what you want to call your abcs)
    2. food (and fluids)
    3. elimination (urine, feces and sweat)
    4. temperature control (fever)
    5. sex
    6. movement
    7. rest
    8. comfort (this is where pain belongs)
    the next tier is safety and security needs. the sequence from top priority to the bottom is as follows:
    1. safety from physiological and psychological threats (falls)
    2. protection
    3. continuity
    4. stability
    5. lack of danger
    there is no guessing to this. using a system such as maslow, it is all laid out for you. knowing the definitions of your nursing diagnoses will help you know what "needs" each nursing diagnosis is addressing so you can determine where they fit into maslow's hierarchy. if you have a copy of
    nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig you will find them already classified and sorted out for you on pages 1326-8.
  10. by   missninaRN
    Quote from Daytonite
    Yes. All actual existing problems must be sequenced first. Risk for constipation is not a real problem, but an anticipated one. Therefore, it takes lowest priority and goes to the end of the line.

    If you had, for example, both:
    1. Risk for constipation (physiological need), and
    2. Risk for Impaired Family Functioning (love and belonging need)
    they would be sequenced as I have them because constipation is classified as a physiological need and impaired family functioning is classified as a love and belonging need. On Maslow's Hierarchy of Needs, physiological needs take priority over love and belonging needs.

    So, would "risk for infection" or "risk for violence to self and others R/T history of violence" come after an actual diagnosis like "urinary incontinence"?
  11. by   Daytonite
    Quote from missnina
    so, would "risk for infection" or "risk for violence to self and others r/t history of violence" come after an actual diagnosis like "urinary incontinence"?
    yes.

    actual diagnoses
    (functional, reflex, stress, total, or urge) urinary incontinence (physiological need)
    anticipatory diagnoses (in priority order)
    risk for infection (safety and security need)
    risk for self-directed violence (self-esteem need)
    risk for other-directed violence (self-esteem need)
  12. by   missninaRN
    Thanks to everyone for their input. I think I've got it finished!
  13. by   RNinJune2007
    So, in a case with two priority DX's such as Chronic or Acute pain and Impaired Skin Integrity, am I right in my thinking that the pain is first, THEN the impaired skin integrity?

    This prioritization thing is still getting me in my fifth semester!

    Thanks in advance...
  14. by   Daytonite
    Quote from RNinJune2007
    So, in a case with two priority DX's such as Chronic or Acute pain and Impaired Skin Integrity, am I right in my thinking that the pain is first, THEN the impaired skin integrity?

    This prioritization thing is still getting me in my fifth semester!

    Thanks in advance...
    No, you are wrong. Both pain and an open would are problems that involve the physiological needs of the body. Pain is an issue of comfort; an open wound (impaired skin integrity) is an issue of nutrition. Think of this from another direction. Physiological needs are important in order to keep us alive. By ignoring pain and an open skin wound, which has the greater risk to kill you if you don't do something to promote it's correction? Ever hear of pain routinely killing people? Ever hear of wounds killing people? Wounds can become infected because of delayed healing due to poor nutrition. The potential to go septic and then kill them is a lot greater than a person, let's say, taking a gun and blowing their brains out or having a heart attack from unresolved pain. So, which do you think carries a greater priority? The Impaired Skin Integrity does.

    How about another direction? The patient came into the facility for treatment. Was the reason for treatment of the pain or the wound? Where is the major attention of the treatment being given? How many patients do you see being admitted for THE sole reason of pain control? Not many, although it can happen, it's not likely to on a medical unit. And, if it does, it's going to be well-known to the staff that this is why the patient is there—for adjustment and dosing of pain medication.

    I think that it's natural for people to think that attending to pain should be a priority because it is often something that patient's are most often complaining about ("Nurse, please do something about this pain!") rather than their open wounds ("Nurse, please do something about this wound!"). However, when there is an open wound that cannot be ignored and has the potential, if not attended to, to become infected, then it takes priority over pain. So, the sequence of priority should be:
    1. Impaired Skin Integrity (nutrition)
    2. Acute or Chronic Pain (comfort)
    Keep in mind that physiological needs are #1 priority. Whatever is likely to end up killing you fastest and first is what gets sequenced first. That is why oxygen and nutrition are at the top of the list. Without oxygen, parts of you start to die within minutes. Without oxygen your brain is gone in 4 minutes. Without oxygen cells in other parts of the body die (as with infarcts). Without food you eventually die as do individual cells as well. If you can't eliminate your waste and it backs up in your system--bye-bye. Ask anyone who had a bowel obstruction or renal failure. And, so on as you move down that list I gave a few posts ago.

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