Problem Prioritization
NURSING DIAGNOSIS &
CUES RANK JUSTIFICATION
Chronic pain related to
inflammatory process as
evidenced by reports of pain
and easy fatigability.
Subjective:
The patient verbalizes,
“Sumasakit pag
kumikirot”
Objective:
Guarding behavior
Facial grimace while
standing up
Visible signs of
inflammation in the
affected area
Pain scale of 7/10
Vital signs:
RR: 24 cycles per minute
PR: 103 bpm
BP: 140/100
1st
This has been the prioritized problem
according to the sequence of ABC,
MAAUAR method, and Maslows.
In the absence of airway, breathing, and
cardiovascular function problems, the
priority problem should be the pain based
on MAAUAR paradigm which includes:
>Mental status problem
> Chronic Pain
>Acute impaired urinary elimination,
>Unresolved needs
>Abnormal diagnostic test result
>Risk
In line with this, acute or chronic pain
should also be addressed first as it
causes changes in client’s homeostasis
and cooperation on the procedure.
Moreover, the nurse is also capable of
addressing this concern with appropriate
interventions.
Ref:
Brunner&Suddarth’s Textbook of
Medical-Surgical Nursing, Volume 1, 13th
Edition
Establishing Priorities: NCLEX RN of
Registered Nursing Organization.
Ineffective breathing pattern
related to diminished lung
function as evidenced by
tachypnea, dyspnea, and
utilization of accessory
muscles when breathing.
The client verbalized that:
that he was a smoker 6
years ago with 1 pack (20
2nd This has to be the second prioritized
nursing diagnosis because of the
following reasons:
>With aging, there is a decreased
functioning of the respiratory system that
may result to hypoxia and/or hypoxemia
which can pose the client in more serious
complications.
> An older client with ineffective breathing
problem, who has a history of smoking
can easily develop or acquire respiratory
diseases due to the damage brought
