Which diagnosis nursing most important

christina731 · May 22, 2014

Well it really depends on your assessment data. Acute pain could be related to an MI or a sprained ankle. What evidence do you have for these diagnoses?

adel5991 · May 22, 2014

Hi thanks for your response. I see what you mean. I'm trying to base which one is most important according to Maslow. Would risk for malnourishment be more important than risk for infection because in Maslow food is placed in the category of psychological which is more important than safety which is linked with infection?

btw these are just general nursing diagnosis.

christina731 · May 22, 2014

Hi thanks for your response. I see what you mean. I'm trying to base which one is most important according to Maslow. Would risk for malnourishment be more important than risk for infection because in Maslow food is placed in the category of psychological which is more important than safety which is linked with infection?
btw these are just general nursing diagnosis.

Well according to Maslow's I would say risk for malnourishment is important. But from a safety standpoint I would say risk for infection. It's hard to just pick one without more info.

missmollie, ADN, BSN, RN · May 22, 2014

If you could do one thing for the patient who at this exact moment...

1. Is experiencing pain

2. He's at risk for malnutrition

3. He's at risk for infection

Which do you do? What does "at risk" actually mean?

Answer those questions, and I think you'll have it all figured out.

springchick1, ADN, RN · May 22, 2014

I've been told to ask myself, what's going to kill the patient first. Anything that is an At-risk for is a lower priority because they aren't actually having these problems. It's something they MAY experience.

Episteme · May 23, 2014

Well according to Maslow's I would say risk for malnourishment is important. But from a safety standpoint I would say risk for infection. It's hard to just pick one without more info.

Even when using maslow's hierarchy... you have flexibility.

For instance, a week ago a patient's main problem was oxygen, uh... he OD'd on heroin and aspirated vomit...he was tubed and put on a vent. Now that is resolving, he's getting ready to wean but he still has the ET tube in. But then, he develops an ileus. Belly gets distended, we're worried he might throw up tube feed, no bowel sounds... OK. The guy is still on a vent. And whereas airway clearance might have been #1 two days ago, that has stabilized and a new urgent problem has emerged (gastrointestinal motility.) The airway clearance and gas exchange diagnoses didn't go away, they just dropped in terms of priority.

Does that make sense?

And, I think (again... depending upon your assessment data) I think pain is on that foundation level of physiological needs... in as much as it causes major problems.

I had a patient who had a big back surgery. We used all the finesse we could with muscle relaxants, pregabalin, opiates, toradol... everything. She would NOT get out of bed. Days of this. (I think we took her foley out and she had to get up to pee.) But I could not mobilize her because of pain. Sure enough... she developed a hot swollen calf from a big deep vein thrombosis... and she had to go on an anticoagulant regimen. SO... in that case... even with her incision and everything else... I'd put pain first as a physiological problem.

I believe this is how most bedside nurses handle these things. It seems logical to me.

ellaballet · May 23, 2014

I'd say pain just because its the only actual problem. The rest are just possibilities that are important to prevent.

Wave Watcher · May 23, 2014

I say pain. You can act on it now. You can help with the pain now. You can assess the pain after medication within 30min or so and know if it is working. The others is more of a process.

adel5991 · May 23, 2014

Hmm I agree. Would you also say risk for malnourishment is more important than risk for infection?

Wave Watcher · May 23, 2014

I would say infection comes first. Just my opinion. Although, being malnourished will affect how you heal but infection can cause death (worse case scenario) probably a lot quicker than being malnourished.

RunBabyRN · May 23, 2014

We weren't allowed to use risk diagnoses as our key ND. Actual vs. potential is important to consider.

That said, look at your whole patient. What's going on with them? There isn't enough info here to really determine what's most important. If their pain is low, but their wound healing is slow because of diabetes and poor self-care, then risk for infection and malnutrition might be more important, ya know? You really have to consider everything that's going on. I hope that helps some.