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NURSE DOJO Cheat Sheet
Lesson 1.1 · Management of Care

Establishing Priorities and Clinical Decision-Making

Must-know rules
  1. ABCs first. Airway → Breathing → Circulation. A beats B beats C. Always.
  2. Maslow's next. Physiological → Safety → Love/Belonging → Self-Esteem → Self-Actualization. Lower always beats higher. Pain is physiological. Teaching is self-actualization.
  3. Assess before acting. Unless the stem gives you complete critical data or the patient is in cardiac arrest, anaphylaxis, or hemorrhage.
  4. Acute over chronic. New-onset or changing findings beat stable baselines.
  5. Unstable over stable. Trends matter more than single values. A rising HR tells you more than a single reading.
  6. Trace the patho chain. The patient closest to a life-threatening complication, the one whose body is decompensating, is your priority.

WHY PRIORITIZATION MATTERS

DOJO RULE
Prioritization isn't about right vs. wrong: it's about first vs. later. All four answer choices might be appropriate actions.
THE DOJO DECISION LADDER
  • ABCs: Airway → Breathing → Circulation. First filter, always.
  • Maslow's Hierarchy: Physiological → Safety → Psychosocial.
  • Assessment before Intervention: Gather data before acting.
  • Acute over Chronic: New or changing trumps stable baseline.
  • Unstable over Stable: Changing vitals demand immediate attention.
  • Pathophysiology Reasoning: Trace the chain to predict who deteriorates fastest.

THE ABCs: YOUR FIRST FRAMEWORK

DOJO RULE
A always beats B. B always beats C. A laryngeal edema patient (airway) takes priority over a patient with tachycardia (circulation), even if the tachycardia looks scarier.
KEY DISTINCTION
Stridor = Airway. Wheezing = Breathing. Stridor indicates upper airway narrowing (A).

MASLOW'S HIERARCHY IN NURSING

KEY RULES
Pain is physiological: don't rank it as safety. Teaching = self-actualization: almost never the first action.

ASSESSMENT BEFORE INTERVENTION

EXCEPTIONS: ACT IMMEDIATELY WHEN:
  • Cardiac / respiratory arrest: Start CPR. Don't assess lung sounds first.
  • Anaphylaxis with complete data: Stop the offending agent, give epinephrine.
  • Active hemorrhage: Apply direct pressure. Don't take a BP first.
  • The cause is still running: Stop the blood transfusion, stop the IV medication.
DOJO RULE
The exception test: "Did the question stem already give me enough data to know exactly what's happening?" If yes, act.

PATHOPHYSIOLOGY REASONING

  • HEART FAILURE → PULM EDEMA: Chain: Pump failure → ↓ CO → fluid backup → pulmonary congestion → pulmonary...
  • DVT → PULMONARY EMBOLISM: Chain: Venous stasis → clot → embolization → PA occlusion → V/Q mismatch → right...
  • BRAIN INJURY → HERNIATION: Chain: Injury/bleeding → ↑ ICP → ↓ cerebral perfusion → brainstem herniation...
COMPENSATION VS. DECOMPENSATION
Compensating: the body is coping: ↑ HR, ↑ RR, patient is anxious but alert.

MULTI-CLIENT PRIORITIZATION

THE 4-STEP MULTI-CLIENT METHOD
  • Classify each client by ABC level. Does anyone have an airway, breathing, or circulation issue.
  • If tied on ABCs, apply Maslow's. Physiological > Safety > Psychosocial.
  • If still tied, check acute vs. chronic. Who has a new or changing finding? Who is at baseline.
  • Trace the patho chain. Who is closest to a life-threatening complication? Who is compensating vs.
DOJO RULE
In multi-client questions, eliminate the clearly stable / expected / chronic patients first. That usually leaves 2 contenders.
FINAL DOJO RULE
In multi-client questions: eliminate the stable/expected patients first. Then apply the Decision Ladder to the remaining contenders. Systematic beats instinct. Every time.

Memory hooks

ABC A Airway · B Breathing · C Circulation
ADPIE A Assess · D Diagnose · P Plan · I Implement · E Evaluate
Please Save Lazy Exam Students P Physiological · S Safety · L Love and belonging · E Esteem · S Self-actualization