Which Has Priority? Pain or Nutrition?

[HappyMeNow]

I had to go back and edit my original post. I have to do a nursing diagnosis for a patient who came in with chronic pain from ulcer and because of that hasn't been taking her meds and on the morning of her ER trip she had fallen down at home.

So I have two columns where I need to fill in physiological needs and one column for psychological needs. Based on her info that I gathered, I know that her physiological need would be knowledge defit related to medication; Does that sound right? She is a diabetic and she wasn't eating because she was in pain and therefore not taking her diabetic meds.

For her physiological needs I'm torn between risk for falling, pain, and nutrition deficit. Which one should I leave out and which order should they be in? I was thinking of leaving out nutrition, and putting fall risk first and then pain?

Could someone please help?

TIA!

[Fig77]

I would say pain in short term. But in the long run food/nutrition should take priority, which would be in your patient case scenario. This is because without proper nutrition your patient won't Heal her ulcer and remain at risk for nutrition defiit due to diabetes. And this could result in more pain.

Fall risk should come last since that goes within Safety and security.

[Sarah Hay]

Pain.

[Daytonite, BSN, RN]

here is the list if maslow's hierarch of needs:

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
  

as you can see, the need for comfort falls below the need for food and water. that means that nutrition has priority over pain. i will almost always sequence a nutrition diagnosis over acute pain. some nursing instructors, however, are adamant about sequencing acute pain first. you will need to determine if you have instructors that do that. pain will not kill you. not getting food and fluid will which is how maslow's hierarchy is based. without food and fluid she will die (take a really good look at maslow's list). not taking her medication or eating is a problem with her thinking and decision making. falling is a safety issue. this patient's ulcer is the cause of her pain (tissue destruction) and as it is treated by the physician will heal and the pain will go away.

when care planning you always assess the patient first. this is the data that you provided:

• she's diabetic - you should look up diabetes and be aware of its signs and symptoms as well as its pathophysiology and complications. in particular, what gi problems can occur in diabetics? look up gastroparesis.
  
• fallen down at home
  
• hasn't been taking her diabetic meds - what are the consequence of this? did this ulcer have any chance of healing with elevated blood sugars?
  
• wasn't eating because she was in pain - what kind of nutrition problems has she experienced? weight loss? elevated blood sugar levels? what was her daily calorie intake? was it assessed? people with wounds need larger amounts of protein and things like vitamin c and zinc. what was her protein intake like?
  
• chronic pain from ulcer - an ulcer is merely internal tissue destruction that is occurring. pain happens when certain pain receptors (specialized nerves) are stimulated. (see this post for the pathophysiology of pain: https://allnurses.com/nursing-student-assistance/does-anybody-here-218963.html - does anybody here have a pathophysiology for pain?)
  

now, from that information you determine the nursing problems (nursing diagnoses) and sequence them according to maslow's hierarchy of needs:

1. imbalanced nutrition: less than body requirements - you need more specific evidence of this such as weight loss if she says she is not eating [physiological need for food]
   
2. chronic pain r/t irritated gi mucosa secondary to ulcer aeb [evidence of pain] [physiological need for comfort]
   
3. ineffective health maintenance r/t impaired ability to make appropriate judgments aeb not taking her diabetic medication or eating (because of abdominal pain) [safety need for protection]
   
4. risk for falls r/t elderly female, history of falling, and changes in blood sugar levels [anticipated safety need for protection]
   

[DolceVita, ADN, BSN, RN]

Um...dumb question but surely those in acute pain aren't going to feel like eating? I am just a student so obviously no experience with this other than personal.

[Daytonite, BSN, RN]

Um...dumb question but surely those in acute pain aren't going to feel like eating? I am just a student so obviously no experience with this other than personal.

But it is not an appropriate etiology for the diagnosis of Imbalanced Nutrition: less than body requirements. Look at the definition and related factors associated with it.