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:
- Impaired Skin Integrity (nutrition)
- 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.