Fundamentals of Nursing: Client Prioritization

Client prioritization is a nursing fundamental that is exercised in various hospital settings, especially after the client has gone through a traumatic situation or surgery. After going through the importance of prioritizing airway, breathing, and circulation, we’ll head on to the other concerns that nurses should focus on.

In this lecture, we’ll consider a client who has just gone out of the surgery room. Once you are done assessing for the client’s ABC, what should be the next area of importance? With cases like this, you always have to think about what’s going to kill the client the fastest. So, which among the following should be assessed after the ABCs?

• Altered level of consciousness
• Bleeding due to dehiscence and evisceration
• Infection or sepsis
• Pain
• Elimination
• Skin integrity

Maslow’s Hierarchy of Needs

Maslow’s Hierarchy of Needs theorized that if a client has established an appropriate airway, breathing, and circulation, the next aspects that should be given importance to should be safety and infection.

Elimination, nutrition, and pain come in after the ABCs and safety and infection.

Constipation is a common elimination issue that nurses encounter with post-operative clients. If a client is experiencing hard bowel movement, stool softeners or laxatives should be provided.

Pain will be given priority if the client has just had knee-replacement surgery or other orthopedic surgeries, for that matter. Clients who are complaining of pain will be assessed for:

• Perfusion
• Sensation
• Motor movement
• Pulses
• Worsening, unrelieved pain

Compartmental Syndrome

Pain experienced by clients who underwent total knee replacement could indicate that he or she has compartmental syndrome.

Compartmental syndrome means that the client is suffering from internalized bleeding within the fascia portion of the muscles. As the fascia is filled up with blood, it produces a little sac that causes circulation to be cut off. One of the most significant indications of compartmental syndrome happening is that when the client grumbles about pain. And pain is the first indication that the client is in distress.

The Second Tier

As mentioned, the second tier will involve elimination, nutrition, pain, and skin integrity.

Pain moves on top of the second tier once it has something to do with chest pain – could be myocardial infarction or angina (stable or unstable). Because when this happens, it means that there is a lack of oxygen in the heart.

Skin integrity can lead to pressure ulcers which can cause infection. Nutrition is vital in this aspect because it can influence a client’s skin health, above everything else.

As mentioned, elimination is primarily concerned with either defecation or urination. Is there a small bowel obstruction that can cause proliferation and can lead to fatality?

The Third Tier

Client teaching and psychosocial aspects come in third when prioritizing. Client teaching is mostly concerned with imparting important information with clients regarding their health and lifestyle changes.

When it comes to discharge planning, client teaching always comes last. On the other hand, when prioritizing, saving lives is more important than educating clients.

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