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. Disaster color tags live in Emergency and disaster triage. This chapter owns the frameworks you use when several clients compete in ordinary care.

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.

Work airway then breathing then circulation unless the stem already shows a dead patient (no pulse), in which case CAB-style CPR logic takes over. 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 first. 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. Suicide risk is a safety-tier emergency once ideation with plan appears. It can outrank routine physiologic comfort tasks, but it does not outrank an obstructed airway in the next bed.

Acute versus chronic, unstable first

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.

Chronic disease is not automatically low priority. Chronic heart failure with new pink frothy sputum is acute-on-chronic and wins. The word chronic in the stem is a clue only when the complaint is the client's usual baseline. The distractor that looks organized is finishing morning meds on four stable clients before checking the one whose family says he is not himself.

A practical order after report

1. Scan for ABC threats across the assignment.
2. Among remaining clients, pick unstable or unexpected change next.
3. Prefer acute over chronic baseline complaints when acuity is otherwise similar.
4. Use Maslow when the leftover choice is physiologic versus psychosocial.
5. Assess before non-rescue actions when data would change the plan.

This order prevents the common exam error of jumping straight to a psychosocial or teaching task because it feels productive. Productivity is not priority. Survival and stability are.

Priority map