Untitled

• These notes cover priority setting, Maslow's hierarchy of needs, the nursing process, client care focus, and risk reduction in healthcare settings.

Priority Setting Framework

• Determining which client to see first and identifying the most important assessment finding are key aspects.
• Deciding which interventions to provide immediately versus later is crucial in prioritizing care.
• Understanding the proper sequence of steps for procedures and emergency interventions is essential.
• Identifying situations posing immediate risk to client safety is a top priority.
• Delegating tasks appropriately is an important aspect of prioritization.

Maslow's Hierarchy of Needs

• Physiological needs include oxygenation, nutrition, elimination, fluid balance, activity, exercise, rest, and sleep.
• Safety and security needs involve living in a safe environment, having adequate income, and shelter.
• Love and belonging needs encompass love, affection, and relationships, often met through community and spiritual groups.
• Self-esteem needs include self-respect, personal worth, and social recognition.
• Self-actualization needs involve personal growth and fulfilling one's potential; Maslow believed few achieve this level.

Client Care Focus

• Higher levels of needs in Maslow's hierarchy may compete with lower levels depending on the client's situation.
• It is important to consider all client factors before determining the order of care.
• Assessing the client first is most important in the nursing process: data collection and evaluation of client outcomes to see effectiveness of care plan.

Airway, Breathing, and Circulation (ABCs)

• Assessing airway, breathing, and circulation is the initial and top priority.
• Alteration in any of the ABCs could indicate threat to life or need for resuscitation.
• Airway is the highest priority action: must be open and clear, and may require a temporary oral or artificial airway or supplemental oxygen.
• Breathing is the second highest priority and is essential for oxygen exchange, aiming for a respiratory rate within the expected reference range with adequate ventilatory effort.
• Circulation is the third highest priority, maintaining heart rate and blood pressure within the expected reference range to ensure adequate cardiac, cerebral, and peripheral perfusion.

Implementation of ABCs

• Chemical and/or physical cardiac support may be needed.
• Resuscitation might be necessary.
• Supplemental fluids might be required to re-establish intravascular fluid volume and blood pressure.
• Health care providers frequently use ABCs for order of care, especially in emergency situations.
• The ABC approach helps recognize early signs of complications.

Safety and Risk Reduction

• Assigning priority to factors or situations posing the greatest safety risk or threat to the client's physical or psychological well-being.
• Addressing risks: identify if it is a safety risk to the client. consider the risks to the client's physical or psychological well-being.
• When facing multiple risks, using another priority setting framework helps identify which poses the greatest threat.
• An immediate threat usually becomes the highest priority.

Client Care in Risk Reduction

• Assess for external factors: complete risk assessment, integrate interventions, and use assistive devices.
• Assess for internal factors: ABC combined with safety and risk reduction.

Least Restrictive/Least Invasive Interventions

• Prioritize interventions that are least restrictive and least invasive to the client.
• Ensure chosen interventions do not put the client at risk for harm or injury.

Client Care Focus for Restrictive Interventions

• Least restrictive interventions include close and constant supervision/assessing medications/bed and wheelchair alarms/mattress on floor next to client's bed.

Restraints

• Protect clients' civil and legal rights.
• Unauthorized use of restraints can lead to assault, battery, or false imprisonment.
• Utilize least restrictive methods before physical restraints, using them only when the client, staff, or others' safety is at risk.

Least Invasive Interventions

• Least invasive interventions can include addressing bladder routines for incontinent clients/incentive spirometers or inhalation treatments/oral or rectal administration of medications.
• Reduce the number of organisms introduced into the body to prevent hospital acquired infections.
• Reduce client infections to reduce the need for antibiotics.

Emergent Situations

• Class I is life-threatening injuries, immediate treatment is required for any chance of survival.
• Emergent Class I injuries have the highest priority.

Other Classifications and Prioritization

• Urgent: is Class II, involves serious/extensive injuries, does not pose an immediate threat to life, potential for survival with treatment.
• Nonurgent: is Class III, involves less serious and extensive injuries, does not pose a threat to life, and delayed treatment has no threat to life even with.

Other Scenarios

• Expectant: is Class IV, injuries not compatible with life, survival potential is not possible even with care, scare resources are reserved for Classes I, II, and III.
• Acute vs. Chronic: Acute needs may pose more of a threat than immediate, chronic needs develop over time.
• Unstable vs. Stable: clients who have needs that pose threats to survival.
• Unstable: Unstable clients have needs that pose threat to client's survival. Life-threatening needs often involve airway, breathing, or circulatory status.
• Attend to alterations in the acute phase before they evolve into a chronic alteration.
• Client at risk for becoming unstable has higher priority than clients who are stable.

Frameworks

• In mass casualty situations when resources are scarce, clients least likely to survive have the lowest priority.
• Clients with severe injuries but potential to survive with treatment have the highest priority.
• Choose a framework most applicable to the client's situation and consider using a second one to support the first.
• Support frameworks like Maslow's Hierarchy or airway, breathing, and circulation (ABCs) should be used.