focus assessment/prioritizing

[trayyhawk03]

I am a first year nursing student and right now we are learning how to do a focu assessment and how to prioritize when you go into a patient's room. The scenario that my teacher gave us was, You have a patient yelling that he can't breathe, another patient, who's blind but needs to get up and go to the bathroom, and the third patient is a diabetic who's hungry but needs his blood sugar checked before he eats...the problem that i'm having is trying to prioritize on what to do first. Can anyone give me any advice on how to prioritize? Please? By the way this is for LVN program

[jeepgirl, LPN, NP]

hint abc

[keno138]

You may think about it like this... Who will die first? Treat the respiratory problem first.

[OregonGal]

Remember CPR??? THINK ABC, as previous poster...

Airway, Breathing, Circulation. "Can't breathe" is a priority. Need to ask more questions about "can't breathe", and do focused assessment (airway, lungs, allergies??)

:)

[txnursingqt]

Not a nursing student yet but I like to read these posts for insight. I figured that you would help the person who can't breathe first, but who comes second?

My instinct says get the person to the bathroom and then take the blood sugar but I am not sure and I am not basing that on anything that I have learned since I haven't learned anything yet. LOL Just a guess.

[racing-mom4, BSN, RN]

THat is tricky as my 1st thought is if he is yelling well then he is apparently breathing....I wouldnt want the blind man to fall trying to get to the bathroom.

I hate prioritizing questions!!!

I do agree always go with the ABCs, so I am sure the comment "I cant breath" is going to be the 1st one you check on...

[Daytonite, BSN, RN]

prioritizing is often done by maslow's hierarchy of needs which includes the abcs (need for oxygen). the physiological needs, the first part of maslow's pyramid, looks like this:

1. physiological needs (in the following order)
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort

[*]safety and security needs (in the following order)

• safety from physiological threat
  
• safety from psychological threat
  
• protection
  
• continuity
  
• stability
  
• lack of danger

[*]love and belonging needs

• affiliation
  
• affection
  
• intimacy
  
• support
  
• reassurance

[*]self-esteem needs

• sense of self-worth
  
• self-respect
  
• independence
  
• dignity
  
• privacy
  
• self-reliance

[*]self-actualization

• recognition and realization of potential
  
• growth
  
• health
  
• autonomy

so, for

• a patient yelling that he can't breathe
  
• a blind person the needs to get up and go to the bathroom
  
• a diabetic who's hungry but needs his blood sugar checked before he eats

will be attended to in this order:

1. a diabetic who's hungry but needs his blood sugar checked before he eats (physiological need for food)
   
2. a blind person the needs to get up and go to the bathroom (physiological need for elimination) note: the need for help to get up and be guided to the bathroom is a safety need which comes after a physiological need on the hierarchy. the physiological need, however, takes priority this time.
   
3. a patient yelling that he can't breathe (love and belonging need) - a person who is having trouble breathing cannot yell out that they are having trouble breathing. this patient is most likely confused and/or trying to get attention. as long as he's yelling, he is breathing.

here is a weblink to a presentation and explanation of the human needs:

• http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

[trayyhawk03]

THat is tricky as my 1st thought is if he is yelling well then he is apparently breathing....I wouldnt want the blind man to fall trying to get to the bathroom.

I hate prioritizing questions!!!

I do agree always go with the ABCs, so I am sure the comment "I cant breath" is going to be the 1st one you check on...

Well you're absolutely right....my teacher says that if pt. is yelling, then apparently he can breathe---she say's to help blind man first so that he won't fall, then send a CNA to go do blood sugar and then Go and assess the man that's unable to breathe---See how tricky it can be? That's been my problem, I know that it should be ABC, but I know that it's not always that way---thanx alot!

[trayyhawk03]

Remember CPR??? THINK ABC, as previous poster...

Airway, Breathing, Circulation. "Can't breathe" is a priority. Need to ask more questions about "can't breathe", and do focused assessment (airway, lungs, allergies??)

:)

my teacher says to help blind man to the bathroom first, so that he won't fall, then send CNA to go do blood sugar, and then assess the pt. that's unable to breathe, because if he's yelling, mthen he must be able to breathe....so, that's why I'm confused! I would think to help the pt. who couldn't breathe first!

[trayyhawk03]

hint abc

Well I thought ABC first, but my teacher says that if a person is yelling that he can't breathe, then he must be able to breathe since he is yelling....she said to first help the blind person to the bathroom, so that he won't fall, send a CNA to do the blood sugar, and then assess the pt. who's unable to breathe....So this is why I am confused!!! I would think to check on the breathing first!

[txnursingqt]

prioritizing is often done by maslow's hierarchy of needs which includes the abcs (need for oxygen). the physiological needs, the first part of maslow's pyramid, looks like this:

1. physiological needs (in the following order)
   • the need for oxygen and to breathe [the brain gets top priority for oxygen, then the oxgenation of the heart followed by oxygenation of the lung tissue itself, breathing problems come next, then heart and circulation problems--this is based upon how fast these organs die or fail based upon the lack of oxygen and their function.]
     
   • the need for food and water
     
   • the need to eliminate and dispose of bodily wastes
     
   • the need to control body temperature
     
   • the need to move
     
   • the need for rest
     
   • the need for comfort

[*]safety and security needs (in the following order)

• safety from physiological threat
  
• safety from psychological threat
  
• protection
  
• continuity
  
• stability
  
• lack of danger

[*]love and belonging needs

• affiliation
  
• affection
  
• intimacy
  
• support
  
• reassurance

[*]self-esteem needs

• sense of self-worth
  
• self-respect
  
• independence
  
• dignity
  
• privacy
  
• self-reliance

[*]self-actualization

• recognition and realization of potential
  
• growth
  
• health
  
• autonomy

so, for

• a patient yelling that he can't breathe
  
• a blind person the needs to get up and go to the bathroom
  
• a diabetic who's hungry but needs his blood sugar checked before he eats

will be attended to in this order:

1. a diabetic who's hungry but needs his blood sugar checked before he eats (physiological need for food)
   
2. a blind person the needs to get up and go to the bathroom (physiological need for elimination) note: the need for help to get up and be guided to the bathroom is a safety need which comes after a physiological need on the hierarchy. the physiological need, however, takes priority this time.
   
3. a patient yelling that he can't breathe (love and belonging need) - a person who is having trouble breathing cannot yell out that they are having trouble breathing. this patient is most likely confused and/or trying to get attention. as long as he's yelling, he is breathing.

here is a weblink to a presentation and explanation of the human needs:

• http://en.wikipedia.org/wiki/maslow's_hierarchy_of_needs

thanks daytonite. what do you think about the op saying that their teacher said to take the person to the bathroom and send a cna to take the blood sugar? is that what you would suggest too? i love your thoughts and they always help explain things to me so that is why i ask.

[Daytonite, BSN, RN]

Thanks Daytonite. What do you think about the OP saying that their teacher said to take the person to the bathroom and send a CNA to take the blood sugar? Is that what you would suggest too? I love your thoughts and they always help explain things to me so that is why I ask.

I would attend to the diabetic first because of their blood sugar needing to be assessed. Blood sugar assessments are done on a regualr schedule. The last time I was hospitalized I waited for over half an hour while my dinner tray was getting cold for someone to come and take a Glucometer reading on me. I don't know what the holdup was but if it was a blind guy who needed to be walked to the bathroom he better have been busting at the seems to pee. Helping a blind person is a safety issue and can wait a few more minutes over a diabetic that needs food and blood sugar control.