Overview
This lecture covers key models and frameworks for patient prioritization in nursing, including the nursing process, Maslow's hierarchy of needs, ABCs, and specific prioritization scenarios.
Models of Patient Prioritization
- The nursing process follows the steps: assess, diagnose, plan, implement, and evaluate (ADPIE).
- Always start with assessment before moving to diagnosis, planning, or interventions.
- Maslow's hierarchy prioritizes physiological needs before safety, love/belonging, esteem, and self-actualization.
- Address basic physiological issues before psychological or safety concerns.
ABC Priority Framework
- ABC stands for Airway, Breathing, and Circulation, in that order, except during CPR.
- Airway threats (e.g., stridor, GCS < 8, anaphylaxis) take priority over breathing or circulation issues.
- Breathing issues (e.g., asthma attack, COPD exacerbation) come before circulation problems.
- Circulation issues include bleeding or compromised blood flow.
Acute vs. Chronic & Expected vs. Unexpected
- Acute problems (sudden asthma attack) take priority over chronic issues (stable COPD).
- Unexpected findings (new leg swelling in CHF or sudden crackles) are higher priority than expected, stable symptoms.
Least to Most Restrictive/Invassive Interventions
- Begin with the least invasive/restrictive interventions before progressing to more invasive or restrictive measures.
- For urinary retention, try simple methods before catheterization.
- For restraints, use de-escalation and non-physical interventions before physical or chemical restraints.
Mass-Casualty Triage & Survivability Potential
- In mass-casualty incidents, care is prioritized to save the most people.
- Prioritize patients likely to survive with intervention (e.g., open fractures, sucking chest wound).
- Lowest priority goes to those with little or no chance of survival (e.g., penetrating head wounds, no pulse).
- Walking wounded (minor injuries) receive the lowest urgent care priority.
Key Terms & Definitions
- Nursing Process (ADPIE) — Sequential steps: assess, diagnose, plan, implement, evaluate.
- Maslow's Hierarchy of Needs — A pyramid of needs starting from physiological up to self-actualization.
- ABC — Airway, Breathing, Circulation model for setting clinical priorities.
- Acute vs. Chronic — Acute: sudden and severe; Chronic: ongoing, managed over time.
- Expected vs. Unexpected — Expected: usual for the patient's condition; Unexpected: new or abnormal findings.
- Least Restrictive/Invasive — Start with interventions causing the least limitation or risk.
- Mass-Casualty Triage — Sorting patients to maximize survival in large-scale emergencies.
Action Items / Next Steps
- Review leadership and fundamentals flashcards for patient prioritization.
- Test yourself with end-of-lecture review questions on Maslow’s, ABCs, and triage.
- Prepare for exam questions by practicing prioritization scenarios.