This is a good question. I am thinking the Digoxin is the priority. Cardiac pts who do not receive their digoxin on time are at risk for cardiac arrhythmias. And, Dig increases the contractility of heart, so this could include the circulation aspect. I think this choice is the most important, especially for a cardiac pt. A cardiologist would flip out if a pt went into a-fib and saw that the dig was given late.
2nd and 3rd are a toss up b/c you could argue the two....
The antibiotic is important b/c it is timed. With Q6 hr dosing, you have to stay on schedule. Plus, hospitals get dinged when pts receive antibiotics late, especially with pts at risk for sepsis. JACHO is very serious with antibiotic timing.
Asthma pts are priority due to airway and breathing but Singular is a maintenance med and it's a long-term, daily drug used for prevention. The main treatments for asthmatics are oxygen and short-acting bronchodilators, but Singular is used to prevent bronchospasm, which is important. But, it could be argued that it's more of a chronic, preventative-type drug that doesn't do anything in the short term for hospitalization. Singulair is often used as an add-on with other treatments. If this choice was Albuterol, it would definitely be first, but I am kind of on the fence with this one.
The insulin would be last. I am thinking the "daily dose" is probably a long-acting insulin, so the coverage has already been on-going. But, glucose control is important.
So, I pick dig, antibx, singulair, insulin. Maybe even dig, antibx, insulin, singulair.