How to know which diagnosis is of higher priority

llg, PhD, RN · Apr 7, 2015

You can't decide on a priority on the basis of a medical diagnosis only. The priority depends on what is happening with the patient at the time. Something that is immediately life-threatening would always take precedence over a more stable situation even if the diagnosis for the stable condition is going to eventually be the cause of death.

For example:

If the patient is sitting there coughing up a storm, having difficulty breathing and turning blue from his COPD, that problem shoots to the top of the priority list because it needs to be addressed immediately. But if a COPD patient is sitting there breathing easily, but sitting in stool from his incontince ... clean him up before you give him his respiratory treatment.

It's not a matter of memorizing a list of diagnoses in a particular order of priority ... it is a matter of assessing the patient and determining which problem needs to be addressed first in this situation. As a general rule, things that are life-threatening come first ... things that put the patient at risk are also high priorities ... as are things that cause discomfort.

ShelbyaStar · Apr 7, 2015

We practice NCLEX questions a lot in lab, often it's prioritizing.

ABC- airway, breathing, circulation.

By this standard, I would probably put COPD and maybe the suctioning ahead of the other things. COPD involves breathing, depending on the situation suctioning could involve airway, putting that first.

Also there's real vs. risk. Knowing there is an actual problem vs someone being at a "risk for".

Basically think, who's going to die first if left unattended?

But I agree, you can't really prioritize based on the information given.

If this is more for a care plan, which it sounds like it is, I would choose whichever has the biggest impact on the person's life. Based on info given, I might do a care plan for ineffective airway clearance, since that covers both COPD and partially immobility. But really, it's whatever the current Big Problem is. What is the predominant reason that they predominantly being cared for?

For example, I've had a patient that had a huge stage IV sore, so my priority was impaired tissue integrity. I don't care so much about her arthritis or that she's a bit overweight. Another recently had an amputation, so getting his diabetes under control so that he doesn't lose the other leg is more of a priority than his depression. Etc.