Are risk for diagnoses always a lower priority than actual ones?

jelly221,RN, MSN · Feb 23, 2012

I'm working on my care plan and I need 5 nursing diagnoses. I have 3 actual and 2 risk-for diagnoses already and I'm wondering if I should prioritze them the same or put the risk-for as lower priorities. Thank you for any advice.

We need more information before we can help you. What are the diagnoses you have? Also, a little background info about the patient would be nice. I'd say that generally actual go before potential. However, what if your "risk for" is "risk for decreased cardiac output r/t infarction of 50% of myocardium AEB decreased EF on echo, ST-elevation in septal & anterior leads, etc." and your "actual" diagnosis is "Anxiety r/t uncertain prognosis AEB pt states 'My Dad died of a heart attack, what if I'm next?'"

My point is, you have to think critically. Use Maslow's hierarchy of needs, and think about what could actually kill or do serious harm to the patient. Daytonite has a great post (many great posts) but there's one specific to prioritizing diagnoses, maybe search for it and I'll see if I can find it.

Hope that helps. =)

jelly221,RN, MSN · Feb 23, 2012

Here's a couple of Daytonite's threads:

https://allnurses.com/nursing-student-assistance/understand-how-write-225330.html

https://allnurses.com/general-nursing-student/help-care-plans-286986.html

And of course you can always look through other old posts:

https://allnurses.com/search.php?searchid=1774686

cayenne06, MSN, CNM · Feb 23, 2012

I have to say that I have always, always been told that actual goes before risk, no matter what. I got points off on a project when I put something like "risk for impaired gas exchange " above "impaired mobility." Both were equally valid, but IMO (especially considering the case I was presenting), the risk for impaired gas exchange was definitely a higher priority as it was an acute case.

So, in real life you have to base it upon your patients and it is basically common sense. For nursing school, I would clarify with your instructor. I wouldn't be surprised if your nursing dx book lays it out for you too. I am not sure what NCLEX has to say about this issue.

Unknown member · Feb 26, 2012

In my first semester in nursing school, I too learned that actual dx are always higher priority than risks.

THEN...

We had our first test that had a question regarding a fresh post-op patient

Which diagnosis is highest priority? (I don't remember all 4 choices)

1) Pain

2) Risk for Aspiration

The entire class picked pain but the answer was risk for aspiration. I quickly learned that you can't base priority on what the textbook says. I realized after the fact that risk for aspiration makes sense as the main priority after surgery b/c you have to remember Maslow's and your ABC's.

I don't know if that helps, but it certainly changed my perspective! :)

llg, PhD, RN · Feb 26, 2012

Short answer: No. Sometimes the risk is so great, that it trumps a minor problem. A patient with a high risk of great harm would need you to protect his/her safety before you addressed an actual minor irritation that was causing no great harm.

For example: If the patient is about to be consumed in a fire, but also has an actual hangnail that hurts a little ... Save him from the fire before you do anything with the hangnail.

The best way to answer a question such as yours that involves words such as "always" or "never" is to think of extreme examples to see if the "rules" hold up in even extreme cases. If they don't hold up, then you know the "rule" is not really true.

Example #2: A patient is at significant risk for falling -- and has a minor problem. You put the side rails up first (or whatever else needs to be done to prevent falling) before you address the minor problem.

KimberlyRN89, BSN, RN · Feb 27, 2012

I always Dx by Maslow's & ABC's first, then the ones that aren't extremely serious (activity intolerance for example), and then risk for's.

ER(notso)n00b, ASN, RN · Feb 27, 2012

Thanks so much for the replies. I honestly cannot even remember the details on that patient anymore since we are already onto the next one. In one class we were told to always put risk-fors at the bottom. My clinical instructor said it doesn't matter, a higher priority is a higher priority. As in, the risk for aspiration could be higher than acute pain in some circumstances. I feel like I've lost about 30 IQ points since starting this program! Just when I think I'm getting the hang of it, I feel dumb all over again.

VickyRN, MSN, DNP, RN · Feb 27, 2012

Totally agree with llg on this one. "Risk for" (potential) diagnoses can be higher priority than actual diagnoses.... Risk for Falls, Risk for Injury, Risk for Aspiration, Risk for Infection, just to name a few. It depends on the client's unique circumstances. Maslow's Hierarchy and the ABCs are the major consideration.

For instance, if you have a confused incontinent elderly client with brittle bones who is unsteady on her feet and also prone to wander, and your plan of care helps prevent this client from falling during your shift, then you helped prevent many devastating nursing problems from developing. In this case, an ounce of prevention is worth a pound of costly cure.

I am a nursing instructor and this is what I tell my students in helping them determine which nursing diagnoses are high-priority.

nurseprnRN, BSN, RN · May 23, 2014

If all the question is asking is to rank three (like activity intolerance, nutrition imbalance, ineffective breathing pattern), it's not a question with an answer. NO nursing diagnosis exists in a vacuum; no nursing diagnosis is one-size-fits-all. EVERY nursing diagnosis must be applied after assessment of the particular patient's presentation.

Examples:

1) Your patient is a 13-month-old baby with an acute asthma exacerbation. He is a little pudgy for his age and when he's not fighting for breath has activity normal for age. His nursing diagnosis priorities, in order, are likely to be: ineffective breathing, activity intolerance (because he's short of breath), and imbalanced nutrition, more than body requirements.

2) Your patient is a 13-month-old baby with marasmus (look it up). His resps are shallow, he is weak and flaccid. His priorities are likely to be imbalanced nutrition, less than body requirements, activity intolerance, ineffective breathing pattern

3) Your patient is a 13-month-old baby with mitochondrial disease (look it up). He is a little thin; his resp rate and sats are normal for age. His priorities are likely to be activity intolerance, imbalanced nutrition, less than body requirements, ineffective breathing pattern.

nurseprnRN, BSN, RN · May 27, 2014

Has this question been adequately answered yet?