Prioritizing in Diagnosis

[Succulent x Arts]

Hi! We were tasked to create a Nursing care plan, I'm having a hard time identifying which one to prioritize. 

Diagnosis:

1.    Fluid volume deficit related to active fluid volume loss as evidenced by severe lady partsl bleeding.

2.    Impaired gas exchanged related to decreased oxygen-carrying capacity of blood as evidenced by oxygen saturation of 90% or mild hypoxemia.

3.    Decrease Cardiac output related to alteration in the heart’s functioning as evidenced by tachycardia, hypotension, and change in level of consciousness.

4.    Risk of injury related to unconscious state.

[amoLucia]

What do you think??? Only you know what this pt's most pressing problem is thru your assessment.

ABCDs?

We can help you refine your thought processes, but you have to explain yourself.

[Succulent x Arts]

I was thinking of the ABCDs, if it would be followed, I believe I’d have to prioritize the impaired gas exchange. But I was thinking the cause of impaired gas exhange is the bleeding itself or the fluid volume deficit.
 

I’m going for the fluid volume deficit since I believe it’s the most pressing problem and the cause of all other diagnosis, the patient also doesn’t show sign of difficulty in breathing, so I chose to address the blood loss. Any thoughts? 

[amoLucia]

No airway issue. No breathing issue. Cardiac??? D??? I always thought of D as definitive - anything else that might be life threatening, like the blood loss (or something else like severe hypoglycemia or status asthmaticus, etc?)

Which might be the most life-threatening issue for your pt???

Cardiac because of the hypovolemia with all its sequellae???? Makes sense to me, but I'm NOT the expert. The hypovolemia is also the quickest & easiest thing to correct - at least to my thinking.

Risk of injury when unconscious??? Not now. Watch their VS and monitors and pull up the siderails.

Any other more knowledgeable ones out there to comment?

[AdamChemPhd_EMT, EMT-B]

I mean, I'm just an emt, but in our assessment, apparent life threats (ie, severe bleeding) come before even airway.  I'd say a serious bleed which is probably the source of the cardiac issue (hypovolemic shock) and the respiratory issue is the priority.