How do you categorize patient stability?

[jb32]

I was just wondering how do you categorize the stability of a patient (e.g. stable, moderately stable, unstable, etc.)?

I'm assuming it has to do with ABC's, but what makes a patient moderately stable, or not stable? What types of diagnosis would fall under the various categories?

Any help would be appreciated. Thank you.

[jb32]

For example, where would a patient coming in with asthma be categorized? Where would a patient with chest pain be categorized? How about a patient with a broken leg?

[GHGoonette, BSN, RN]

Hi, I'm assuming this is a study question, and directed more at emergency nursing techniques and nursing diagnosis. The protocols we use in PACU would probably not be of any help, right?

[jb32]

Yeah, I guess you can say it's a study-type question, but is used in real-life critical care. I'm not sure if the protocols in PACU would correlate, but my question has to do with, like I said, categorizing a patient as stable, unstable, moderately stable, etc. For example, a young patient that comes in with a couple of lacerations from falling down while running, with nothing wrong other than the scrapes, would be categorized as stable, I'd assume. A patient with a trach, unconscious, I'd assume would be unstable? I'm not sure what moderately stable would be. So with that said, your experience in PACU may help, you tell me. Any insight would be good.

[gentlegiver, ASN, LPN, RN]

Just my humble opinion, but, I was taught that a patient was "stable" if all VS were WNL, no (extensive) bleeding, and if thier mental status was at thier baseline. But then I work LTC, so it might be different in a hospital sitution.

[Altra, BSN, RN]

Yeah, I guess you can say it's a study-type question, but is used in real-life critical care. I'm not sure if the protocols in PACU would correlate, but my question has to do with, like I said, categorizing a patient as stable, unstable, moderately stable, etc. For example, a young patient that comes in with a couple of lacerations from falling down while running, with nothing wrong other than the scrapes, would be categorized as stable, I'd assume. A patient with a trach, unconscious, I'd assume would be unstable? I'm not sure what moderately stable would be. So with that said, your experience in PACU may help, you tell me. Any insight would be good.

You may want to re-read whatever material preceded this study exercise as it may help you answer the questions from the perspective of what is being presented in the material. If you're being asked to practice categorizing patients then surely you've been given some tools to use to do that.

The patient scenarios in your post appear to be patients presenting to an emergency departmen-type setting, not admitted to a critical care unit. But there is much information lacking, e.g., the "unconscious" patient with a trach may have been that way for months/years.

[casi, ASN, RN]

I tend to categorize patients as things such as peachy, icky, makes me uncomfortable, the patient I don't trust, and hot mess. Then again these are only used in verbal report.

[emtb2rn, BSN, RN, EMT-B]

I've seen stable and unstable hot messes. Usually some flavor of bipolar and/or borderline for the unstableness.

I like the term craptapular.

Tell us more about your homework assignment and what YOU think about stable vs unstable.

[ZippyGBR, BSN, RN]

early warning scores ?

their current critical care 'level' likelihood of changing critical care level whether (up towards l3 ICU or down back towards ward care) ?

[nursej22, MSN, RN]

Any patient transferring to our cardiac tele unit is "stable", especially if it is shift change.

But often a serious decline occurs somewhere in the transfer process but no one notices until the patient arrives.

[resumecpr]

Does the patient need help with ADLs?

Are they on any critical drips?

Do they have a central line?

Are they on telemetry?

Has there been any unpredicatble events (like a code, fall etc).

Do they or the family need emotional/spiritual communication or educational support?

Restraints/Seclusion?

Wound/Skin care?

Pulmonary Care (vent, NC, Bipap)?

Isolation?

From there categorize if each of these topics are simple, moderate, complex, or NA.

This is what I use at my hospital for assigning acuity and staffing.

[eaRNed]

I feel it's generally a grey area at times. I usually look at patients as stable, stable at the moment (but soon to be unstable), and unstable. Someone with chest pain, diaphoretic, with an altered mental status is obviously not stable. Someone who is becoming bradycardic with only symptom being palpitations could be considered somewhat stable but my guess is, 9 times out of 10, this won't last for long. It's hard to put defining factors on such a broad area but generally any sudden change in LOC, or basically a new-onset of anything would make me think either unstable or soon to be there. I hope this helps :)