Need help determining the order in which to see the following patients

[c_croke]

Here are the five patients:

1. PNA, Back Pain

2. HTN, LIKELY C-DIFF, ARF also had recent R hip FX

3. subdural Hematoma, FX. right foot S/P fall, UTI, on 1 to 1

4. Vomiting, Diarrhea, Hyperglycemia

5. UTI, ? seizure

My thoughts were:

Pt. with PNA, back pain first since his diagnosis is airway/breathing related diagnosis.

Pt. with likely C-diff, and Acute Renal Failure because she has a fresh hip FX and is needing to use bathroom frequently

Pt.vomiting, Diarrhea and hyperglycemia

Pt. with subdural hematoma

Pt. with UTI and ? of seizure activity

Any insight would be greatly appreciated;)

[One Flew Over]

I'm in no way an expert, but here's my thought process, lets see if any of it makes sense lol :)

1. I agree with the PNA, back pain, because of the potential airway difficulty - I would assess his airway/lungs, etc

2. Subdural hematoma, FX of foot, UTI on 1 to 1, because it sounds like this pt has a lot going on and I would want to get a good neuro assessment.. Also since the 1 to 1 is probably because of agitation/restlessness I would perhaps try to find a cause for the restlessness (could it be a sign of IICP?)

3. UTI and seizure activity - I would do a neuro assessment and make sure that seizure precautions are in place.

4. Vomiting, diarrhea, hyperglycemia - I would want to make sure that I check his/her blood sugar in advance for breakfast because I would need to get in the insulin before they eat (if needed) I would also want to give an anti-emetic at least a half an hour before their breakfast if they are still nauseous.. I would probably normally see them earlier, however they don't seem to be urgent enough to bump them ahead of the previously mentioned patients.

5. HTN, likely Cdiff, fresh hip fx - I feel like they don't have anything that urgently needs attention like the other patients. I also feel like while they may have to be using the commode often that's a task that could be delegated to the CNA (not that I wouldn't gladly do it, don't get me wrong! :) )

I'm a nursing student as well, so I'm probably not completely on target! But I do love this critical thinking stuff, so if you want tell me what you think of my reasoning.. etc, we can always bounce some ideas off each other! :)

[c_croke]

We were given more info, and also had these 5 patients for a day. Here is a little more info that led me to my decission:

The subdural hematoma pt. had a 1 to 1 because she has short term memory loss (not related to the hematoma) the 1 to 1 was there to remind her not to bear weight.

The pt. with likely C-diff and fresh hip replacement was literally having 20-25 BMs a day, and due to the fact that she has ARF she is really at risk for electrolyte imbalances, she also has an IV running that would need to be checked.

The pt. with vomitng, diarrhea, hyperglycemia was a recent admit and was still having urgent BMs several times, also has an IV that needs to be checked (we were taught to always check our IVs at change of shift)

The pt. with UTI and ? of seizure had not had any seizure activity while in the hospital, she has dementia and the person that sent her in from the rehab she was at said she stared of to the side for 20 seconds. To me, a 96 year old with dementia starring off to the side for 20 seconds isn't all that unusual.

[One Flew Over]

The extra info definitely changes things! I thought this was an exercise you guys did in class or something! I didn't know you actually had those patients, all of your reasoning makes sense.