Why isn't pain with physiological needs

[direw0lf, BSN]

We've been learning care mapping and ADPIE for a couple weeks and this is just a pet peeve or something but why do you not count pain in the first tier? Especially as it's a 5th vital (or 6th depending where you put o2). We were told to prioritize the nursing diagnoses using Maslow's. And nutrition comes before pain. Is it like that in the real nursing world too? Every time I see a question and pain is in the multiple choice I keep feeling like I'd just want to address pain first because then wouldn't it decrease stress and help the physiological problem too?

[BeachsideRN, ASN]

Sometimes you do address the pain (comfort) first, sometimes you don't. It depends on the situation.

[SubSippi]

You don't put pain in the first tier, because pain never killed anyone. In he real world, I would address someone's pain before I worried about their diet because they probably won't be eating if they're hurting.

It all depends on each specific situation. But with prioritization questions in school, pain is hardly ever going to be the first choice. Why? Because it won't kill you.

[NurseGirl525, ASN, RN]

Most certainly nutrition comes before pain. Yes, addressing the pain will help with other issues, but when looking at Maslows those basic physiological needs come first. It doesn't matter is someone is in pain if they aren't breathing. Pain doesn't matter if their nutrition is in the toilet so bad it can kill them. Yes, pain is a vital sign, and it is important, but their basic needs to keep the person alive come first.

I feel like you are not understanding Maslows here. It something that honestly comes with practice. The first tier is all about looking at how the patient is functioning to stay alive at that moment. If you have a patient who's kidneys are failing, what is the first thing you are going to do to keep that patient alive? You are not going to treat their pain first, you are going to try and fix the problem with the kidneys so they don't die. If a patient is having an MI and they stop breathing, you need to get them breathing again, not worry about their pain. I know that kind of seems obvious, but that is what I am trying to show you, that if they are so dire that they could die, you need to treat that first. That's kind of what they pyramid is about. Next tier is safety. So if your patient is stable, but they are not safe, that would be your priority. If they are a fall risk, and have pain, your priority is the safety, then the pain.

It's always appropriate to treat a patient's pain. But when it comes to prioritizing what needs to be done first, you look at Maslows. And when you are prioritizing, just because pain comes maybe third, that doesn't mean you are waiting hours to treat that patient's pain. You can still ensure their safety and treat their pain at the same time. It might be as simple as making sure seizure precautions are in place at the same time you administer their pain pill. But you need to ensure those fall or seizure precautions are in place. I hope that makes a little more sense.

It took me a bit to get those priorities straight. Those were the only points I missed in clinical my first semester. I didn't prioritize correctly on my care plan. It's a mistake I no longer make.