Priority Diagnoses

[cbaker1]

I am working on care plans for four patients in home health or hospice. Our instructor told us to pick complex pts with and complex diagnoses. I have identified multiple diagnoses for each pt, but I am not sure which ones to use as priority. I know that Airway Breathing & Circulation always have priority, and actual comes before "risk for" are there any other rules to go by? Some of the pts don't have problems with ABC's, what do I do in this situation?

[Daytonite, BSN, RN]

nanda has the nursing diagnoses classified into domains and classes. if you look at some of the diagnoses and their definitions you can see that some are obviously physiological in nature and have to do with how the body works such as decreased cardiac output, constipation, decreased and excess fluid volume, hyperthermia, impaired skin integrity or ineffective airway clearance. then there are others that clearly have to do with how and what we do in our lives such as activity intolerance, impaired physical mobility, imbalanced nutrition, or the self-care deficits. there is another grouping you can refer to as psychosocial diagnoses because they address how people behave and act such as ineffective coping, impaired verbal communication, grieving, low self-esteem, anxiety or social isolation. patient problems should be listed out and placed is a hierarchy. maslow can help you with this. maslow developed a pyramid of what needs were most important to sustaining life. physiological needs comes first. all the nursing diagnoses can be classified on the maslow hierarchy of needs. here is a website that explains maslow's: http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs. and this is what the hierarch looks like:

1. physiological needs (in the following order)
   
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort
     

[*]safety and security needs (in the following order)

• safety from physiological threat
  
• safety from psychological threat
  
• protection
  
• continuity
  
• stability
  
• lack of danger
  

[*]love and belonging needs

• affiliation
  
• affection
  
• intimacy
  
• support
  
• reassurance
  

[*]self-esteem needs

• sense of self-worth
  
• self-respect
  
• independence
  
• dignity
  
• privacy
  
• self-reliance
  

[*]self-actualization

• recognition and realization of potential
  
• growth
  
• health
  
• autonomy