Mr. Jones is an 88 year-old patient transported to the Emergency Department by EMS. Patient's chief complaint was acute substernal chest pain (8 out of 10 on a pain scale). Vital signs include: BP 98/58, HR 108, RR 26 (labored), and Temperature 99.5F. Med HX: COPD, Hypertension, Diabetes (insulin-dependent), Pneumonia, and Depression. Consider the following question pertaining to this case.
1. As the Emergency Department nurse caring for this patient, in what order would you select (list in the order of priority) the interventions needed to care for this patient?
a. Connect the patient to a cardiac monitor
b. Apply a pulse oximetry to the patient
c. Take a fingerstick to test blood glucose
d. Take a non-invasive blood pressure
e. Insert an intravenous line
f. Insert a urinary catheter
2. Based on your list of prioritized interventions, answer the following question: What rationale did you use to prioritize the order of each of the above interventions? (Please write clearly and support your answer with evidence-based research).
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Two points:
1) Only 2 (two) of those steps are INTEREVENTIONS, the others are ASSESSMENTS
2) If this is homework from a class; your instructor has written a BAD/POOR question. The question is not educationally sound. What background in test item writing does your prof/instructor have?
Mr. Jones is an 88 year-old patient transported to the Emergency Department by EMS. Patient's chief complaint was acute substernal chest pain (8 out of 10 on a pain scale). Vital signs include: BP 98/58, HR 108, RR 26 (labored), and Temperature 99.5F. Med HX: COPD, Hypertension, Diabetes (insulin-dependent), Pneumonia, and Depression. Consider the following question pertaining to this case.
1. As the Emergency Department nurse caring for this patient, in what order would you select (list in the order of priority) the interventions needed to care for this patient?
a. Connect the patient to a cardiac monitor
b. Apply a pulse oximetry to the patient
c. Take a fingerstick to test blood glucose
d. Take a non-invasive blood pressure
e. Insert an intravenous line
f. Insert a urinary catheter
2. Based on your list of prioritized interventions, answer the following question: What rationale did you use to prioritize the order of each of the above interventions? (Please write clearly and support your answer with evidence-based research).
1. Attach cardiac monitor and obtain EKG
2. Pulse ox
3. Bp
4. IV
5 Glucose (off Istat BMP)
6. Cathether
A patient with these symptoms, seemingly non-critical, would be attached to the monitor pretty simultaneously by the nurse and the ER tech in my facility. EKG stat is expected with the complaint of chest pain. Glucose can be run off blood collected from IV stick (and blood culture on hold, d/t to hx of COPD, pneumonia and low grade temp). Cathether I only placed on the list because you mentioned. This pt would not automatically get a foley, depends on severity of symptoms. Foleys only increase risk of UTIs
This is the official answer from my instructor. Would you dispute the order? Why?
Order of Priority:
1.Apply a pulse oximetry to the patient.
The patient's RR is 26 and labored. Pulse oximetry readings provide a continuous database on the respiratory status of the patient.
2.Connect patient to a cardiac monitor
Patient's chief complaint was acute chest pain. Continuous cardiac monitoring provides essential information regarding cardiac rhythm changes and abnormalities.
3.Take a non-invasive blood pressure reading
Vital signs include BP readings and should be taken immediately in emergency situations to monitor hemodynamic status.
4.Insert an intravenous line
Having a direct IV access for emergency medications and fluids is critical given the unstable signs and symptoms of this patient.
5.Take a fingerstick to test blood glucose
The patient is an insulin-dependent diabetic. It is imperative to monitor the patient's blood glucose since stress events may increase the level of blood glucose.
6.Inserting a urinary catheter
If fluid volume is considered in the treatment of this patient, the insertion of a urinary catheter may be considered.
I can see why o2 sat will have higher priority over cardiac monitor even though the patients chief complaint has to do with the chest pain. For one breathing ces before circulation and secondly the patient was laboring at breathing at high rate.
mwboswell
561 Posts
Two points:
1) Only 2 (two) of those steps are INTEREVENTIONS, the others are ASSESSMENTS
2) If this is homework from a class; your instructor has written a BAD/POOR question. The question is not educationally sound. What background in test item writing does your prof/instructor have?