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Discussion

HELP! Prioritizing nursing intervention

Assessment:

V/S-39.4-105-32-154/82, SpO2 84%. Crackles, diminished breath sounds. Green sputum when coughing, left chest pain. Non-smoker. 

Past hx: CAD, MI, (+) stent

Present med hx:  Metoprolol(Lopressor), amiodipine(Norvasc), lisinopril(Zestril), furosemide(Lasix). Glucophage& Glucotrol for DM2. 

How do I prioritize following orders?

 VS q 2h

 Blood culture & sensitivity STAT

 Metaproterenol sulfate (Alupent) 0.4% q 3h

 Give O2 to maintain SpO2 over 90% 

 CBC & diff. count & BMP

 CXR now and in the morning.

 D5 1/2 NS 125mL/hr IV

 Ceftriaxone (Rocephin) 1g q12h IV

 2,100 kcal DM diet

 

 

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    I'd talk with your classmates. Quick thoughts from me:
    Always culture before administering ABX. So grab that and your other bloodwork before Rocephin. ABC, so oxygen first. Some of these routine things are weird, so like is it time to take vital signs and give food? Maybe VS soon too. I would go: O2, VS, blood culture/CBC, other meds while they're coming in with CXR, then diet at the end. I don't know if you're starting the IV. This is such a weird question and I hope they're not grading you on a correct order. 

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    OP - it would have been most helpful to you and your learning process if you had given us your thoughts FIRST before PP helped out to start you in the right direction. That's how you'll learn!  I'd go:

    oxygen & alupent ; IV running; diagnostics; vs 39.4 = 103 so ???; rocephin; VS; diet.

    Now since we 've gotten you pretty much there, how about YOU telling us  why these orders are so sequenced???

    Also, based on the info given, can you think of some other interventions that may be indicated??? I can think of 3 additionally. No, 4.

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