Help! Prioritise Patients

[NurseJenny21]

I have an oral assessment were I need to basically prioritise 4 patients. I am trying to prepare for this. Our main focus this semester was Respiratory, cardiovascular and neurological systems.

I would need to answer:

1. Which patient is the priority

2. Why?

3. Describe how will I collect cues?

4. Identify which body system first to focus on and why?

Am I correct to answer this as respiratory patient first, administer oxygen, collect cues by ABC's, because respiratory affect the whole circulatory supply and tissue, heart and brain perfusion.

Then what if other patients are having an MI or TIA?

I don't know what to do..

Thanks for your help

[Esme12, ASN, BSN, RN]

Welcome to an! The largest online nursing community!

As always.....we like to know what you think first. Any priority for patients you look for which one is going to die first. ABC's first foremost and always. Each patient scenario you need to look at what the assessment is and vital signs and see which one is more likely to get the sickest first.

[bgxyrnf, MSN, RN]

It's not so simple as that because you can have the highest priority be in any of those categories but also the lowest priorities.

For example:

Patient A is brought in by her family, you find her to have cyanotic lips, audibly coorifice respirations, and a room-air saturation of 77%.

Patient B is brought in by his family who state that 30 minutes ago, he lost the ability to speak and could not stand up. At this time, he is conversing normally and has no facial droop nor pronator drift and has strong and equal grips.

Who is your priority? Patient A obviously... which does happen to be respiratory > neuro.

But what about this:

Patient A is brought in by her family who state that beginning 30 minutes ago, she began having severe left-sided facial droop and speaking in nonsensical sentences.

Patient B arrives and complains of being short-of-breath since getting out of bed this morning. The patient states that she feels better sitting up but is much worse when walking. Parenthetically, she tells you that you simply *must* try that new Mexican food place around the corner where she had dinner last night.

Who's the priority? Patient A, right... pretty obivously having a stroke and is well within the window for thrombolytics. Patient A probably got too much salt in her diet and has exacerbated her CHF. She needs treatment, for sure, but is doing OK.

In this case, neuro > respiratory/cardiac.

Does this make sense?

You have to evaluate individual patients and not try to force it into some simply yes/no, A > B kind of algorithm.

ABCs count (although we've now moved to CAB in CPR/ACLS) but it's just one piece of the clinical picture.

Here's the way I think about it as a triage nurse: Which of these patients is most likely to have an adverse outcome if they do not see a physician in the next 10 minutes?

[LessValuableNinja]

I'm not even sure where to begin. Prioritize correctly. Two of four answers should be obvious. The other two require thought. Is one acute and one chronic? Is one abc? Is one an out of range lab value? Is one an obvious contraindication?

[LessValuableNinja]

Fyi if these are not obvious you should study until they are.

[NurseJenny21]

thank you so much for clarifying that for me. it makes a lot of sense now.

[NurseJenny21]

i think i would need to study more of the pathophysiology of cardio vs respiratory vs neuro. thank you for your response

[AliNajaCat]

i think i would need to study more of the pathophysiology of cardio vs respiratory vs neuro. thank you for your response

Oh, yeah. Physiology and pathophysiology are probably THE most important things for a nurse to know. Why? Because we never see anybody that doesn't have at least one thing wrong with their physiology, even the psych folks. Everybody has a heart and lungs, or if they don't they're dead and we don't have to worry about them anymore.