 Hi and welcome to Nursing School Explained and the second video in the nursing process series where we go into our problem identification and prioritization and formally also known as nursing diagnosis. Now depending on what terminology your program uses you might still be nursing diagnosis which is a little bit of an outdated thing to do but really the principle behind the second stage of the nursing process is the same it's just a matter of labeling and actually calling the problems whatever we call them. And so after we have gathered all the assessment data physical assessment lab data, vital signs, subjective and objective information we use this assessment data to prioritize our patient problems and the steps or orders that we should always take is first addressing A, B and C. So that would be your airway breathing and circulation so whenever we have a problem with any one of those they should be addressed first. Number two we go by Maslow's hierarchy of needs which basically tell us that physical needs always come before psychosocial ones. So that means if the patient is choking on something we're not going to worry about their inability to pay for their hospitalization because they don't have insurance coverage or they're concerned about that. So physical needs always come before psychosocial ones. And then number three actual problems will always need to be addressed before potential or risk for problems. And you might have heard a nursing problem risk for falls, risk for impaired skin integrity, risk for infection, those things are very common out there. But yes, yes, we have to address those because those are potential complications a patient could be suffering. But if they have an actual problem, clearly we need to address this before we address any potential problems, right? You're going to fix the car tire that's broken before you're going to possibly do the oil change when the car is still running well. So just kind of keep that in mind. And then something that students sometimes get confused is how is a nursing problem or a nursing diagnosis different from a medical diagnosis? Medical diagnosis are very specific, mostly designed to match an ICD-9 or ICD-10 code which is basically used for billing purposes. And then they're kind of connected to different diagnostic procedures. But one medical diagnosis can have multiple nursing problems. And let's look at this a little bit here in the example that we started to look at in our first assessment video in our first step here. So the patient's complaint was short of breath. Now the medical diagnosis is congestive heart failure. When we assessed the patient, when we performed physical assessment, we found vitro signs O2 set was 91% and respiratory rate was 24. Lab short of potassium of 3.2 which is low. And in the assessment, we found that the patient has crackles to bilateral bases in the lungs and plus two pitting edema to bilateral lowering extremities. So now if I go back here and I see, okay, based on this assessment data, what do I have to focus on? Well clearly there's a problem with the patient's oxygenation because there are two sets low, they're breathing a little fast and they have crackles in the lungs. So my first problem needs to address their oxygenation. Whatever that might be, so you might call it oxygenation. Some people might call it impaired breathing pattern because it's a little bit high, the respiratory rate, whatever you might call it, right? But the problem is with oxygenation lies within their lungs. Then number two, a problem that we have here while the other physical thing that's abnormal is the potassium is low. And knowing that the potassium can cause some problems with this rythmias, especially in a patient with congestive heart failure, we need to make sure that we address this low potassium and that is a physical need because that could potentially cause a problem. But it is a current actual problem because right now the potassium is low. So then I might call this electrolyte imbalance because the patient is suffering from hypokalemia. So that would be an actual problem and it would be a physical or a psychosocial problem. And then the third thing I have here that's abnormal is that the patient has plus two pinning endema to the lower extremities. Now certainly I'm going to have to assess the patient in greater detail and do a thorough skin assessment on these lower extremities. But I know that when that fluid is in the interstitial space of the legs that the patient is at risk for impaired skin integrity. Now because we don't have any other physical findings here that are abnormal, I'm now going to move into this risk for problem. And I wrote down here risk for impaired skin integrity because of this pinning endema. I know if I don't get rid of this endema or it gets worse, then possibly there could be some problems with wound development with that fluid seeping out of the skin. So keep in mind the order here, right? So we look at the assessment data from step one, we identify what is abnormal, we go in the order by EBC's physical, greater than psychosocial and an actual before potential problems, and we come up with our problem list. Now once we've established the problem list, then we are ready to move on to phase three of the nursing process and come up with the plan of care. And in phase three, basically we establish patient goals also known as expected outcomes that will help us then dive into the interventions in step four that we need. So please stay tuned, watch step three of the nursing process where we dive into planning by using this as an example. Thanks so much for watching Nursing School Explained.