Prioritizing list of diagnoses

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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!

Specializes in med/surg, telemetry, IV therapy, mgmt.
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.

Specializes in NICU.

OH now I'm really confused!!! Based on Maslow's PAIN comes in LAST?!?!! We were taught that PAIN comes in right after the ABC's in prioritizing diagnoses? Also, that SAFETY should be at the top of the list, it shouldn't come before someones sexual needs for example. That's what my preceptors have taught me matter in the real nursing world. So they don't sequence according to Maslows in the real world that I personally have seen so far. You're more apt to get sued over a safety issue as opposed to addressing someones lack of viagra....?!?!?!

Ya'll have me stumped now. OMG:confused: :smackingf can you please explain? HELP HELP HELP

Specializes in med/surg, telemetry, IV therapy, mgmt.
OH now I'm really confused!!! Based on Maslow's PAIN comes in LAST?!?!! We were taught that PAIN comes in right after the ABC's in prioritizing diagnoses? Also, that SAFETY should be at the top of the list, it shouldn't come before someones sexual needs for example. That's what my preceptors have taught me matter in the real nursing world. So they don't sequence according to Maslows in the real world that I personally have seen so far. You're more apt to get sued over a safety issue as opposed to addressing someones lack of viagra....?!?!?!

Ya'll have me stumped now. OMG:confused: :smackingf can you please explain? HELP HELP HELP

Do what your instructors and preceptors at work are telling you to do. You might want to ask them the rationale behind why they are prioritizing pain over all other nursing diagnoses.

maslows baby!

Specializes in NICU.
Do what your instructors and preceptors at work are telling you to do. You might want to ask them the rationale behind why they are prioritizing pain over all other nursing diagnoses.

Thanx Daytonite I've already posted your list and the questions to my instructors' bulletin board to see what they have to say.

You're always SOOO helpful, I'm so glad you're here to help all us nurses to be who are so "green behind the ears" LOL

Specializes in nothing.

It seems to me that Maslow's heirarchy isn't the perfect guide that it seems to be, especially since many of the diagnoses (almost all of them, I think) are related to each other. For example, an earlier post places food and fluid intake over fever management, but personally if I have a fever, I don't feel like eating. So you'd have to make managing my fever the priority before you can appropirately address nutrition.

Maslow's is a good place to start, but it's not the end-all for every situation.

Specializes in med/surg, telemetry, IV therapy, mgmt.

Lafille. . .prioritize however you want, when you are in charge and have the final word. When it comes to getting a grade for the course, fulfilling the requirements of an assignment for nursing school and getting answers right on the NCLEX my advice to all is to do whatever your program directions are. When you play the game, you need to follow the rules or bad things can happen, you know? I'm sure one question where you have to make a decision between addressing a fever or fluids isn't going to decide your fate on the NCLEX, but why chance it?

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