#1 Priority

[Malorymug]

Why shouldn't "Acute Pain" be first priority nursing diagnosis on a care plan? This isn't a test question or an assignment. Feedback from my last care plan said it shouldn't be first.

I almost know, but I'd love to hear other responses. I think it is because we are looking for a cause of the pain to be a higher priority

[KelRN215, BSN, RN]

Well, what were the other diagnoses you had? There are times when pain might be your #1 priority. But there are other times where other issues are more pressing.

[AmyRN303, BSN, RN]

It depends on what the other diagnoses were, I'd think. Your instructor said it should never be a first priority or of your written diagnoses it wasn't number one?

[Malorymug]

I'm sure you are right, it was just for that care plan. My other diagnoses were:

impaired tissue integrity

Ineffective tissue perfusion

Risk for infection

Anxiety

Readiness for enhanced knowledge

Risk for falls.

But when assessing, pain seemed most prevalent. I guess Ineffective tissue perfusion or impaired tissue integrity should have been first since that was the source of the pain?

[JustBeachyNurse, LPN]

Ineffective peripheral tissue perfusion could be an emergent scenario if there is a DVT or absence of pulses. Impaired tissue integrity I'd put 2nd as they can lose a limb due to lack of peripheral tissue perfusion.

Impaired peripheral tissue perfusion

Impaired skin integrity and acute pain can be next (if wound debridement or even a painful dressing change is needed you would address the pain before cleaning, debriding or changing the dressing on a large scale wound)

[KelRN215, BSN, RN]

I'm sure you are right, it was just for that care plan. My other diagnoses were:

impaired tissue integrity

Ineffective tissue perfusion

Risk for infection

Anxiety

Readiness for enhanced knowledge

Risk for falls.

But when assessing, pain seemed most prevalent. I guess Ineffective tissue perfusion or impaired tissue integrity should have been first since that was the source of the pain?

So ineffective tissue perfusion, the patient may end up with an amputation. Pain is not the priority here.

[mrsboots87]

My instructor always tells me to go with airway, breathing, circulation, followed by maslows hierarchy with physical needs and infections taking priority after ABCs. There are of course exceptions, but I am block one so this was the simplified way to prioritize for the level I'm at. So ineffective peripheral tissue perfusion would definitely take priority over pain. Just because something seems like it is more prevalent to the patient, doesn't mean it is the priority. You would definitely want to treat the pain and find the source, but if the patients O2 and blood is not circulating well then that is more important.

[RescueNinjaKy]

Remember abc, what is tissue perfusion? It's the blood carrying oxygen to the cells/tissues so in other words it's part of your circulation priority. It comes before pain not because it is the cause of pain but because impaired circulation (in this case tissue perfusion) is the priority and can lead to bigger problems. Some examples like ischemia, compartment syndrome. Pain is a high priority thing but it's not going to kill you or cause permanent damage. After you handle all abc issues is when you go to pain. More and more hospitals are focusing on pain management but remember that it's secondary to abc

[Esme12, ASN, BSN, RN]

Another example...your ACUTE MI is having crushing chest pain but what will kill him? No cardiac perfusion. Or they are having chest pain and have massive pulmonary emboli...it isn't the pain that will kill them it is the hypoxia that is going to kill thm.

Stand back and look at the patient...what is going to do them the most harm the quickest.