For an immobile client, which nursing diagnosis has the highest priority?

• A. Impaired gas exchange
• B. Risk for constipation
• C. Impaired skin integrity
• D. Acute pain

Answer: (A)

When determining priority, the most urgent concern is the ability to oxygenate. For an immobile client, impaired gas exchange is the highest risk because problems with breathing can rapidly lead to hypoxemia and respiratory deterioration, which are life-threatening if not addressed promptly. Immobility promotes shallow breathing, atelectasis, and secretions, all of which compromise oxygen uptake and carbon dioxide removal long before other issues like constipation, skin breakdown, or pain become life-threatening.

Therefore, the respiratory-related diagnosis takes precedence. Focus on assessing and supporting breathing: monitor rate, depth, and oxygen saturation; auscultate lungs; encourage deep-breathing exercises and incentive spirometry; reposition regularly; ensure adequate hydration; and manage pain so it doesn’t inhibit effective respirations. Early detection and intervention to maintain gas exchange are essential.