Priority frameworks: ABCs, Maslow, and who to see first

Prioritization items ask one question: who is closest to harm right now. Ethics of consent and DNR comfort live in Ethics and care coordination. Who may hold a task lives in Delegation and assignment. This chapter owns the frameworks you use when several clients compete.

ABCs before everything else

Airway, breathing, and circulation are not a slogan — they are the order in which death arrives. An obstructed airway or failing ventilation kills faster than a dressing that needs changing or a client who wants to talk about discharge fears. When the stem shows stridor, silent chest, SpO₂ crashing, new cyanosis, or a client who cannot speak in full sentences, you go there first.

The distractor that looks caring is sitting with the crying stable client while the quiet one in the corner turns blue. Noise is not acuity. Edge case: if the stem already shows apnea or no pulse, you do not “assess further” — you rescue.

Maslow: physiologic before psychosocial

Maslow’s hierarchy is a prioritization tool on the exam, not a therapy lecture. Lower tiers must be reasonably secure before higher ones drive the first action. Oxygen, circulation, fluid balance, elimination, and uncontrolled pain that threatens stability sit under physiologic. Fall risk and infection control sit under safety. Loneliness, anxiety teaching, and self-esteem work matter — after the body is not crashing.

Why this traps people: anxiety looks urgent because it is loud. A client sobbing about a new diagnosis is real suffering, but a client with SpO₂ 84% who says little is closer to arrest. Treat anxiety after you protect gas exchange — or treat both if you can without leaving the hypoxic client alone.

Unstable, acute, unexpected

Stack these filters when ABCs look similar across clients. Unstable means the baseline just broke or never existed (new admission, fresh OR, changing vitals). Acute beats chronic when both need you. Unexpected beats expected side effects the stem already labeled as normal for that disease.

• See first: new post-op with falling BP, fresh stroke symptoms, new confusion, chest pain with diaphoresis.
• Can wait: chronic stable COPD requesting routine teaching, expected low-grade ache after known procedure with stable vitals.
• Assess before implementing when the next finding would change the plan — unless ABC rescue is already clear.

The distractor that looks organized is finishing morning meds on four stable clients before checking the one whose family says “he’s not himself.” Edge case: expected findings still need a glance if the stem adds a new red flag (expected fever vs new stiff neck).

Priority map