Help with Patient Prioritization

[anangelsmommy, ADN, BSN, RN]

I have a project I am working on for class, I am almost done but there is a part of it that I am stuck on. there are 3 "patients" that I have worked up based on a lot of information I was given, so far I havent had a problem. The problem I am running into is prioritizing the patients and coming up with interventions for them, since they arent real and I dont know them....i guess I can make up interventions based on what I would normally do. but I normall do this after I meet my patients and this is stumping me, just because you have a pt with a dx, they can range from being bed ridden to up and around. Anyway the other thing that is getting me is the prioritization, I am unsure of whether I should prioritize the patients based on their dx or based on their medications or....? I will explain:

pt A - 47y acute coronary syndrome, aaox3, friendly joking and spent 15 minutes in the bathroom shaving and performing am care, normal sinus rythm. complains of 10 out of 10 chest pain, minimal medications but is on lovenox and oxycodone for pain. will be getting an echo today to rule out heart abnormality.

pt B - 65 y lung cancer admitted post chemo with fever and suspected pnuemonia. started on levaquin. is also on lovenox as well as oxycodone for pain, celebrex, nexium. pt/inr shows increased clot time so lovenox is held and vitamin K is started.

pt c - 50 y stroke, has been recieving therapy for the stroke at a local rehab center where he experienced sncope and was brought to the ER. admitted for a bowel obstruction and pneumonia. He is now on heparin, colace, flomax, levaquin, lisinipril, hydrochlorothiozide, aspirin, and florastor.

I thought i should see the pt with acute coronary syndrome first because he seems less stable and no heart issue has yet to be ruled out even though his mood is contrary to his pain level. as far as the care, pt c requires more care but his am care could be delegated to a cna, I felt. pt a can perform his own am care. I am not sure about interventions, I know for sure that pt c needs to be turned regularly for skin integrity, all three need to be checked for bleeding. pt b needs to be taught to eat small frequent meals and to have her blood checked frequently for pt/inr now that she is on chemotherapy, if they continue her anticoagulant. pt c, should have a regular bowel regimen to prevent future bowel obstruction. I would love any feedback and any additional interventions that I have left out, I feel like I have left out a lot.

[Nurse SMS, MSN, RN]

Use your ABCs and Maslow's. Pneumonia would be pretty high up there. First intervention is always to assess, so assess all three for lung sounds, pulse ox, resp rate etc. as highest priority I would think and go from there for management of impaired gas exchange and ineffective breathing patterns, etc.