Help Prioritizing on Leadership Tests......

[brandilovesaaron]

I am a second year student in my last semester. We have to take leadership class as one of our last classes. I am having a hard time with prioritizing what patients in the scenerio I need to see first or last....

My teacher said to go by ABC's if you cant do this go by safety... if you cant do this go by the nursing process... Does anyone else have anymore advice?? I made a 72 on my last test because I wasnt able to prioritize!! I have never been failing a class this bad!! Please help my next test is in two days.... THANKS:o:o:o:o

[Riseupandnurse]

ask yourself, "what is wrong with each patient? is it life-threatening? which patient is most likely to die first, and why?"

use maslow, and if airway, breathing, circulation is threatened, go there first. choose the most unstable patient, especially the patient who has just returned from an invasive procedure or the patient whose complaint may mean something serious. ex: a patient on the cardiac floor is c/o heartburn. give serious consideration to a patient who is the oldest or (peds) the youngest.

don't choose the patient (in most cases) who needs teaching or is having a customer service issue or threatening to go ama.

[Daytonite, BSN, RN]

i don't totally agree with your instructor. the nursing process is the problem solving process that we use to solve situations that come up. you must know this 5-step method and what goes on in each step. when it comes to prioritizing nursing interventions you must understand that nursing interventions are actually treating symptoms that the patient is displaying as a response to their medical condition. medical diseases and conditions proceed in a very logical way from very mild to serious symptoms. this is why we need to learn the pathophysiology of the various diseases and conditions. priority of our actions is determined by which symptoms are being manifested (something you learn from step #1 of the nursing process--assessment) and where they fall on the list compared to all the possible symptoms the patient can have for that condition from the start of the disease to its end (death or disability). part of that prioritizing may involve maslow's hierarchy of needs. the physiological needs come first and in this 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 should not be a priority over a physiological need. the safety needs per maslow come after physiological needs and are:

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

[queenjean]

Additionally, if your instructor is well versed in NCLEX review--

Pain is considered psychological; treat physical threats to wellbeing before psychological threats to well being.

Think ABCs/Maslow, like the others have stated.

Also remember what you can delegate to what practitioner.

Aides can take vitals, feed pts, take care of hygeine needs and simple activity needs.

LPNs can pass meds and perform treatments (like dressing changes).

RNs (for the purpose of testing!!) do assessments, oversee care, address changes in condition, and perform education (including admissions and discharges).

Hope that helps.

[Riseupandnurse]

Yes, assessment comes first but when it comes to prioritizing interventions, assess only until you are confident that an intervention will help. As an example, if someone is having trouble breathing, pull him up in bed before listening to lung sounds.