Master Levels of Nursing Prioritization

The first-level priority problems are health issues that are life-threatening and require immediate attention. These are health problems associated with ABCs; airway, breathing, and circulation, such as establishing an airway, supporting breathing, and addressing sudden perfusion and cardiac issues.

The second-level problems are health conditions that are next in importance. They require immediate intervention to prevent further deterioration. The secondary level can be remembered using the MAA-U-AR method of priority setting which stands for: mental status change, acute pain, acute impaired urinary elimination, untreated medical problems, abnormal diagnostic test results, and risks.

A change in mental status indicates general changes in brain function, such as confusion, amnesia, loss of alertness, problems in judgment or thought, etc. Mental status changes that are neglected could lead to injury, falls, or permanent brain damage.

Acute pain could reveal the presence of actual or potential tissue damage. Pain often means that something is wrong. Untreated pain can lead to tense muscles, restricted ability to move around, skin breakdown, or infection.

Acute urinary elimination problems could suggest obstructions in the bladder or urethra. Complications of untreated urinary retention include urinary tract infections, bladder damage and chronic kidney failure.

Untreated medical problems can lead to a quick deterioration of a patient's health or even death. An example is a diabetic patient who needs insulin; without insulin the patient could experience diabetic ketoacidosis.

Abnormal lab values can signify potentially severe problems and require further investigation. It could indicate a possible problem with the liver, heart, or kidneys.

It is essential to address infections to prevent further worsening. Infections can cause inflammation, pain, delayed wound healing, sepsis, and death. Safety and security issues can lead to an increased risk of falls, injuries, and trauma.

The third-level priorities are matters essential to patient health but can be attended to after the more critical health problems are addressed. Long-term interventions are required to treat these problems. These would include a lack of knowledge, mobility, family coping, activity, and rest.