can some experienced nursing students or nurses help??? of the 4 patients below, which would you consider to have priority problems? i'm leaning toward the uti, but i'm not sure and keep going back and forth. please help!
1. 65 year old female admitted with nausea, vomiting, and diarrhea for three days. possible c-diff, contact isolation vrsa. 4 liter oxygen, nasal cannula. right leg amputated above the knee, left foot deformed. incontinent to bowel. alert and oriented x3.
2. 87 year old female admitted with uti, has anxiety, negative for c-diff, contact isolation mrsa. beside commode with assist. alert and oriented x3.
3. 94 year old female admitted with urosepsis, fell at nursing home abrasions to forehead and knees. dnr #2. 2 liter oxygen, nasal cannula. incontinent to bladder and bowel, complete care. alert and oriented to self.
4. 65 year old female admitted with shortness of breath, exacerbation of copd. standby assist to bedside commode, some stress incontinence. oxygen dependent on 3 liters, nasal cannula
ABC's are a good rule of thumb, but you have to remember that by definition a "rule of thumb" is a quick but inaccurate measurement. ABC's are a good starting point but you may need to dig deeper to break a tie.
Think ABC's but also think severity and potential outcomes. COPD is a threat to airway and breathing, but is fairly easy to manage compared to sepsis. Sepsis also threatens breathing and circulation, with circulation impairment being an understatement when it comes to describing sepsis.
Other than their activity tolerance and O2 requirements, it's hard to gauge the severity of #4's COPD and #3's sepsis. #1 clearly has risk factors, although it's hard to determine what their immediate threats are other than their apparently high O2 needs. What we do know is that a COPD exacerbation can be treated with something as simple as zopenex neb and solu medrol in the ED and the patient can sometimes go home without even being admitted. Sepsis on the other hand, is not such a quick fix and typically requires initial treatment in an ICU and claims far more hospitalized patients than COPD. #3 Doesn't exactly have the benefit of youth on her side either.
Last edit by MunoRN on Dec 10, '10