[Joni's Mom]

I have a prioritization exercise that I'm having trouble with I was hoping to get some advice on what others think.

I'm caring for 8 residents. I just received report and information on the clients, and I need to prioritize my day who I would see first, second, and so on.
starting with room # These are the residents on my unit

101 - Sally 97 y.o. history of dementia. Wandered all night
102 - Lisa 75 y.o. Parkinson's. Tremors persist. Slow gait and wandering.
103 - Sam 86 y.o with CAD. Complaining of chest pain at midnight awake most of the night. He received 2 nitro tabs.
104 - Jeff 89 y.o left above the knee amputation and diabetes. His Blood sugar at HS was 293. On sliding scale and scheduled insulin BID
105 - Mary 93 y.o who just fell. CNA reported no apparent injuries.
106 - Sandra a 100 y.o, bedridden, DNR, asking to die
107 - Melody a 67 y.o in for rehabilitation for a left total hip surgery. Planning on being discharged today.
108 - Allen 88 y.o. history of diabetes on oral agents.

In order I would see
105 - I need to assess Mary, the CNA can not assess
103 - I would then assess Sam for heart rhythm and rate and remaining chest pain.
104 - Checking on the amputation and any s/s of hypo/hyper diabetic reactions
101 - Sally to assess why she was wandering all night
106 - Assessing Sandra for depression
102 - Assessing if the tremors are progressing
108 - Check Allen's Blood Glucose levels and check for hypo/hyper diabetic reaction
107 - Make out discharge teaching plans for Melody

[suni]

I think chest pain is always seen first, however you do not say if he is currently having pain or if he had pain and the nitro resolved it, or does the beginning of your post mean you are just starting day shift.

[Joni's Mom]

Hi
Thanks for the reply. I'm just starting my day and this is the report that I received, so I assume the nitro tabs were successful? Don't know, doesn't say.

[abbythetabby]

Always follow your ABC's. Priorities are Airway, Breathing and Circulation, in that order.

[Joni's Mom]

That's whats confusing me.
Wouldn't you assess a patient that JUST FEll 1st because you dont know if the woman broke a rib and the rib is restricting her breathing?

[suni]

Always your ABC's but if the fall patient were unconsious, had hit her head had a deformity, there are so many varibles, bottom line chest pain and breathing difficulties are first.

[Joni's Mom]

Ok, I'm still having doubts, but this is the order that I prioritied my patients
103
104
105
108
102
101
106
107
Hopefully this is correct.

[Joni's Mom]

Letting everyone know that my instructor said SAFTY comes first and I should have seen Mary the woman that fell first. My first instincts were right always go with your first instincts.

[Kim O'Therapy]

Neat exercise. Thanks for sharing it with us.