Help prioritizing care for pediatric patients

[mainegirl]

I have been given three scenarios for patients and asked what order I would see them after arriving on a shift at 7pm. This assignment is just a discussion but I would like to be better informed. Any ideas would be very helpful. Here are the patients:

a) 2 yr old w/ asthma who arrived earlier in the day in resp. distress, 10% dehydration, and fever. He's in high top crib- no parental supervision/ visitors. He's been getting q2h vaponephrine nebulizer treatment with some positive effect.

b) 13 yr old Female w/ ruptured appendix who had lap appendectomy in morning. Presented to ER night before w/ abd pain, fever, nausea, vomiting. Fecolith found upon surgery. After PACU, returned to floor at 5pm groggy, in pain 8/10, Temp-39.7 po with firmly distended abdomen, no bowel sounds. Parents at bedside, concerned.

c) 18 yr old Male in accident last night, killing his date. On suicide precautions, extensive chest and head injuries where he impacted steering wheel and windshield. Parents at bedside, afebrile, foley, no bowel sounds. Has multiple abrasions and contusions all over, complaining loudly of pain.

I know this is a lot and still there are questions you might have regarding their conditions but this is all I have. I can make guesses based on looking in the books but experience really counts here. Appreciate anyone who has the time and hope it stimulates some thought!

[Gompers, BSN, RN]

B

C

A

[Aneroo, LPN]

A (resp distress!= big red flag for me)

B

C

[lpnstudentin2010, LPN]

ok i am not a nurse but i would go

A

B

C

A first because (1) resp destress and (2) there is noone there to advocate for him. the other two cases have their parents there to try and get their daughter anything he/she needs but the 2 y/o has noone there.

[TiffyRN, BSN, PhD]

A

C

B

Though I don't really think it matters too much other than seeing the Baby with the "Airway/Breathing" issue first. Even if he's improving, he's still on nebs every 2 hrs for a reason. I might would argue that the MVA might have a cardiac contusion and though the surgical belly doesn't sound real stable they really all need to be seen now. Love those nursing school scenarios, I'd sooner repeat dental sugery over and over again than nursing school. God bless you!

[nicolel1182]

i would do:

A

C

B

A first because i think of Airway being first...you always have to think about the ABC's.

Then I would do C, because I think of the hierarcy of needs or however its spelled. He is going to need safety first and he is on suicide precautions, plus he will need somebody to talk to.

and then B

[KRVRN, BSN, RN]

B

A

C

[jeepgirl, LPN, NP]

I would go see the unsupervised baby first.

[mitchsmom]

Just curious, was there a "right" answer for this scenario?

[NotReady4PrimeTime, RN]

My inclination would be to see the surgical abd first... an oral temp of 39.7 and a rigid abd would set off bells for me. I'd do a set of vitals to see where her BP and heart rate are, assessing for onset of septic shock. And a pain score of 8/10 needs to be addressed sooner rather than later.

The toddler with asthma would be next, since he's not supervised. But in my world, effective q2H nebs is considered to be rather stable, so that wouldn't necessarily be a huge factor for me. (I really don't enjoy toddlers with asthma. They are my nightmare patients. Once they start feeling a bit better, it's like wrestling an alligator to give them their nebs.)

The big kid with the MVC injuries would be last. He has family in the room with him to maintain the suicide watch (he'd have to try awfully hard with those injuries to harm himself at this point in time). If he's shouting, then he's got an airway and a BP. Extreme pain usually produces a quite, reluctant-to-move patient who moans and groans, not someone yelling about how much he hurts. So he can wait a bit.

Just my

[Woman_in_love]

13 years old female is first, in my opinion, since she is most likely to have an infection/peritonitis and is most unstable.

[mydesygn]

My inclination would be to see the surgical abd first... an oral temp of 39.7 and a rigid abd would set off bells for me. I'd do a set of vitals to see where her BP and heart rate are, assessing for onset of septic shock. And a pain score of 8/10 needs to be addressed sooner rather than later.

The toddler with asthma would be next, since he's not supervised. But in my world, effective q2H nebs is considered to be rather stable, so that wouldn't necessarily be a huge factor for me. (I really don't enjoy toddlers with asthma. They are my nightmare patients. Once they start feeling a bit better, it's like wrestling an alligator to give them their nebs.)

The big kid with the MVC injuries would be last. He has family in the room with him to maintain the suicide watch (he'd have to try awfully hard with those injuries to harm himself at this point in time). If he's shouting, then he's got an airway and a BP. Extreme pain usually produces a quite, reluctant-to-move patient who moans and groans, not someone yelling about how much he hurts. So he can wait a bit.

Just my

I agree, the belly would worry me more than the 2yo. The 2yo is not on O2, q2h nebs is not that unusual for a floor patient, and his resp status is improving, and you can get a nurses aide to sit with him, if necessary.