Prioritization question

Christine2009 · Oct 3, 2010

I was taking a quiz and I don't understand why I got the answer wrong.
Prioritize these sets of dx using a ranking system (1 most basic):
disturbed body image
constipation, chronic
spiritual distress, high risk for
imbalanced nutrition, less than body requirements.
I ordered them as:
imbalanced nutrition, less than body requirements.
constipation, chronic
disturbed body image
spiritual distress, high risk for
The answer key says I should have switched constipation and disturbed body image. I don't get it. Under any model, physiological comes before mental/spiritual. How is disturbed body image more important to treat than chronic constipation? I get that the pt might have an eating disorder, but isn't clearing up the constipation (reducing risk of other physical issues associated with it) the priority over dealing with the body image? Or is it that the body image issues may be leading to the nutrition problems, which are then leading to constipation? I mean, that probably is it, but why the order of priorities?

The answer seems to be based on Maslow's Hierchy of Needs. In order for a pt to elevate to the next level in the hierchy, (self actualization is the goa)l, but before getting there a disturbed body image would affect the pt performing at thier full level of self actualization.

When you sit back and look at the correct answer I see the rationale behind it.

A disturbed body image could prevent this pt from eating (as you stated) or eating poorly which can cause constipation which then put the pt in distress or at risk for this leading to depression. When you are depressed you do not eat or eat to much.

Do you get what I am trying to say here...lol. Sounds to me like they wanted you to think critically (outside the box) and look at the whole picture and what could come out of putting disturbed body image as the top priority along with listing the other factors that could relate to what would eventually happen if this problem was not addressed first.

HTH!

cmonkey · Oct 3, 2010

The answer seems to be based on Maslow's Hierchy of Needs. In order for a pt to elevate to the next level in the hierchy, (self actualization is the goa)l, but before getting there a disturbed body image would affect the pt performing at thier full level of self actualization.

When you sit back and look at the correct answer I see the rationale behind it.

A disturbed body image could prevent this pt from eating (as you stated) or eating poorly which can cause constipation which then put the pt in distress or at risk for this leading to depression. When you are depressed you do not eat or eat to much.

Do you get what I am trying to say here...lol. Sounds to me like they wanted you to think critically (outside the box) and look at the whole picture and what could come out of putting disturbed body image as the top priority along with listing the other factors that could relate to what would eventually happen if this problem was not addressed first.

I think I get it, but I still don't see body image as being before a physical issue. I spent a few minutes trying to decide which made more sense to come first, and I guess I'm just stuck on it. It still seems to me that Maslow would have concerns about elimination come before the psychological one. I've posted in bb for my teacher but I don't believe I'll get a satisfactory answer. If I get one at all, I'll post it.

Thanks!

cmonkey · Oct 3, 2010

Ah, I found the spot in my ppt notes that I think would back me up: "basic physiological needs must be addressed first". I would think that includes elimination, wouldn't it? I mean, in the long run, both issues would be addressed, so I don't think it's critical that one be first over the other, but I would like to understand the rationale behind the quiz's answer. Unfortunately we don't have that information. Fie!

Mandychelle79, ASN, RN · Oct 3, 2010

I would think it would be fix the body image and the chronic constipation will go away. Fix the chronic constipation, but dont fix the reason why constipation is occuring ( body image) it will reccur.

cmonkey · Oct 3, 2010

Okay, now THAT explaination makes sense. Maybe I just needed it explained that way. Thanks, guys!

~PedsRN~, BSN, RN · Oct 3, 2010

Did you only have the dx as your question?? I mean, was there any background information on the patient? We can't "infer" anything about why disturbed body image is on there. What if this was a post op patient... prostatectomy. That patient might have a disturbed body image because he just had a surgery that might render him sexually dysfunctional. Constipation might be there because of surgical manipulation, etc.

I would have definitely ordered them as you have them.... and I would argue it. In no way would body image come before constipation! Maslow forbids it. LOL!!

cmonkey · Oct 3, 2010

No dx, nothing but what I posted. So yeah, there are ALL kinds of orders it could be in and be appropriate. I haz the frustration.

jjjoy, LPN · Oct 19, 2010

I can see the logic behind the "correct" ranking; it specifically says chronic constipation, which will likely require on-going lifestyle changes to address the root cause. Still, it doesn't really seem to definitely explain the ranking. Just like chronic constipation, balanced nutrition will also require on-going lifestyle changes. One meal isn't going to do it. No change will last without the body image being addressed. Of course, we don't want to put off starting on balanced nutrition until the body image issue is resolved, so imbalanced nutrition trumps body image. But don't we also want to ensure that we're addressing the chronic constipation from the get-go as well? In fact, if good nutrition starts today, that may in and of itself start to address the constipation.

Overall, it's an interesting thought question and can promote a useful discussion of the interrelationship between physiologic and psychologic/spiritual issues. I could see it working as an essay question where it's not the specific ranking so much as the validity of your rationales and applied knowledge that is graded by the instructor. But as a multiple choice test question with just one "best" answer, I don't think it works so well.