Prioritizing list of diagnoses

[missninaRN]

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!

[jamonit]

risk for infection or risk for injury would be prioritized. disturbed energy fields (haha), anxiety, self care deficit would be less important. think maslows.

[jamonit]

most potentials, such as risk for constipation would be after the other actual diagnoses. but i always learned risk for injury and infection tend to be higher prioritzed.

does that make sense?

[missninaRN]

So would a risk for constipation come after an actual diagnosis of impaired family functioning, for example?

[Daytonite, BSN, RN]

This is a very good question.

You prioritize your anticipated nursing diagnoses just like you do your actual diagnoses. Ignore the "Risk for" part for the moment. These anticipated problems can all be classified to such things as physiological, safety and security, love and belonging, self-esteem and self-actualization needs just like all other nursing diagnoses. You know the priority sequence of those, don't you? These sequence the same way. Once you have them prioritized in the proper order you can now add ALL the "Risk for" diagnoses to the end of the ALL your actual nursing diagnoses you have for your patient.

Hope this un-stumps you.

[jamonit]

So would a risk for constipation come after an actual diagnosis of impaired family functioning, for example?

impaired family functioning is before risk for constipation.

pain, risk for infection, impaired family coping, powerlessness, etc. would be for risk for constipation and risk for impaired family coping. see, it's hard to explain, but i think of it like risk for infection could kill--risk for injury (like volume overload) could cause CHF. I used to order my diagnoses by risk for infection, pain, (physio stuff) then psychosocial, then i would do the potential (but less threatening stuff like risk for infection or risk for impaired mobility). it's hard to expain without talking it out, but that's how i did it. what are your nursing diagnoses and i'll help you arrange them...or tell me the med diagnoses and i'll help you come up with the order.

hope that helps!

[Daytonite, BSN, RN]

So would a risk for constipation come after an actual diagnosis of impaired family functioning, for example?

Yes. All actual existing problems must be sequenced first. Risk for constipation is not a real problem, but an anticipated one. Therefore, it takes lowest priority and goes to the end of the line.

If you had, for example, both:

1. Risk for constipation (physiological need), and
   
2. Risk for Impaired Family Functioning (love and belonging need)

they would be sequenced as I have them because constipation is classified as a physiological need and impaired family functioning is classified as a love and belonging need. On Maslow's Hierarchy of Needs, physiological needs take priority over love and belonging needs.

[Daytonite, BSN, RN]

i think of it like risk for infection could kill--risk for injury (like volume overload) could cause chf. i used to order my diagnoses by risk for infection, pain, (physio stuff) then psychosocial, then i would do the potential (but less threatening stuff like risk for infection or risk for impaired mobility). it's hard to expain without talking it out, but that's how i did it. what are your nursing diagnoses and i'll help you arrange them...or tell me the med diagnoses and i'll help you come up with the order.

maslow is very clear on how to sequence! it has nothing to do with medical diagnoses!

http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

within the tier of physiological needs the sequence from top priority to the bottom is as follows:

1. oxygenation needs (this includes what you want to call your abcs)
   
2. food (and fluids)
   
3. elimination (urine, feces and sweat)
   
4. temperature control (fever)
   
5. sex
   
6. movement
   
7. rest
   
8. comfort (this is where pain belongs)

the next tier is safety and security needs. the sequence from top priority to the bottom is as follows:

1. safety from physiological and psychological threats (falls)
   
2. protection
   
3. continuity
   
4. stability
   
5. lack of danger

there is no guessing to this. using a system such as maslow, it is all laid out for you. knowing the definitions of your nursing diagnoses will help you know what "needs" each nursing diagnosis is addressing so you can determine where they fit into maslow's hierarchy. if you have a copy of

nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig you will find them already classified and sorted out for you on pages 1326-8.

[missninaRN]

Yes. All actual existing problems must be sequenced first. Risk for constipation is not a real problem, but an anticipated one. Therefore, it takes lowest priority and goes to the end of the line.

If you had, for example, both:

1. Risk for constipation (physiological need), and
   
2. Risk for Impaired Family Functioning (love and belonging need)

they would be sequenced as I have them because constipation is classified as a physiological need and impaired family functioning is classified as a love and belonging need. On Maslow's Hierarchy of Needs, physiological needs take priority over love and belonging needs.

So, would "risk for infection" or "risk for violence to self and others R/T history of violence" come after an actual diagnosis like "urinary incontinence"?

[Daytonite, BSN, RN]

so, would "risk for infection" or "risk for violence to self and others r/t history of violence" come after an actual diagnosis like "urinary incontinence"?

yes.

actual diagnoses

(functional, reflex, stress, total, or urge) urinary incontinence (physiological need)

anticipatory diagnoses (in priority order)

risk for infection (safety and security need)

risk for self-directed violence (self-esteem need)

risk for other-directed violence (self-esteem need)

[missninaRN]

Thanks to everyone for their input. I think I've got it finished!

[RNinJune2007, RN]

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...