Care Plan Prioritization

[IvyRN2017, ASN, CNA, RN]

Hey everyone!

I am working on my big care plan which is a very daunting task. I was wondering if anyone could offer me any insight as to which direction I want to focus on. My pt came in due to falls and seizures. His admitting dx is a fracture, anemia, and hypokalemia. He ended up aspirating and coding and was admitted to ICU due to acute respiratory distress and was put on a vent. I took care of him while he was in the ICU. Now I'm at a loss. I would think I would want to prioritize my treatment plan according to the acute respiratory distress because of Maslow and the ABC method. However, when I asked my instructor for clarification, she brought up the question of wasn't he brought in for a fall due to seizures? The notes weren't exactly clear as to whether he had a seizure, but he does have a medical hx of seizures. Can any of you lovely people point me in the right direction? My instructor said I could focus on whichever I wanted, even if it was the hip fracture. I just want to do this correctly. Any advice offered would be greatly appreciated!

[Double-Helix, BSN, RN]

Your care plan should focus on the most pressing issues at this point in his care. ARDS is going to be more important than a seizure history that doesn't appear to be an active problem. Also, if he is intubated, he may already be on some kind of benzodiazepine sedation (midazolam, Ativan) that will suppress seizures.

[IvyRN2017, ASN, CNA, RN]

Thank you! I was thinking that also!!!

[AliNajaCat]

And remember that part of your assignment is to justify your prioritizing. There isn't always a textbook clear answer, but faculty want to see your thought processes and communication skill in elucidating them.

[NICUismylife, ADN, BSN, RN]

My instructors always said to base it on what you were doing with the patient all day. Yes, he's intubated, but maybe he was stable all day on the same vent settings. At the same time, maybe he's having dysrhythmias due to the hypokalemia and you spent all day trying to get him into sinus. Or maybe due to the fracture and immobility, he developed a DVT and you're concerned about PE risk. Or you spent all day doing fingersticks and titrating his insulin drip. According to my instructors, any of those would be higher on the priority list because it was what was happening during your shift.

Then again, maybe he kept desatting, and respiratory therapy was in there constantly adjusting his vent. Or his ABGs are way off and the vent has to keep being adjusted because of that. Then respiratory would definitely be priority.

It all comes down to your assessment of the patient, your interventions, and how you had to adjust your plan of care due to changes in status. And above all, you have to sell it to the instructor. They weren't with the patient all day, it's your job to convince your instructor WHY each dx is where on the priority list.

Good luck!