Prioritizing NDx help needed ASAP!

NCRNMDM, ASN, RN · Sep 12, 2011

I'm assuming you use Maslow's Hierarchy of Needs in your nursing classes to prioritize NDx. We do, and our professor recently gave us a handout that breaks each section down and helps us more clearly identify and prioritize problems. I will type it up for you and you can see if it helps any at all.

Area of Need

I. Physiological Needs

A. Oxygen

1. Respiration

2. Circulation

B. Nutrition

1. Food

2. Fluid and Electrolyte Balance

C. Elimination

1. Urine

2. Stool

3. Skin

D. Comfort (rest, sleep, hygiene, pain, etc)

E. Activity

1. Motor Function (bone/muscle)

G. Sexuality

II. Safety and Security

A. Peace of Mind

B. Protection

C. Lack of Danger

III. Love/ Feeling of Belonging

A. Interpersonal Relationships

1. Social (family, peers, etc)

2. Emotional (nurses, etc)

3. Giving and Receiving of Love or Friendship

IV. Self-Esteem

A. Self-Reliance

1. Respect

2. Esteem

3. Confidence

4.Trust

B. Reputation

1. Achievement

2. Leadership

3. Autonomy

4. Independence

C. Leisure-Diversion

V. Self-Actualization

A. Learning

B. Realization of One's Potential

C. Ability to Adapt to Stress

Our professor said that if the patient is in extreme pain and otherwise stable, you should address the pain as your first concern. Otherwise, you are pretty safe in going by this sheet and figuring out what your priorities are. In this situation, you have impaired tissue integrity and ineffective perfusion. Circulation is in the first block of needs, so I think you should prioritize ineffective perfusion first and impaired tissue integrity second.

NrsNikster · Sep 13, 2011

I agree. Always remember your ABC's (airway, breathing, and circulation) in that order and you should be able to put them in the correct order. Oh!! and don't forget Risk for Infection in relation to this situation.

srobb11 · Sep 14, 2011

Hi there! Doubting myself here - need assistance choosing priority ND.
Pt has PAD and a ulceration on his heel from dehissed surgical incision for bone biopsy.
Would you think priority would be impaired tissue/skin or ineffective perfusion?
Impaired tissue /skin seems more emergent, but it would resolve better if we could address perfusion, right?
Help!

Ineffective tissue perfusion results in a lack of oxygen and nutrients at the cellular level and impedes wound healing, so you are correct in your thinking, you need to address the ineffective tissue perfusion first.