Nursing Priority: Who to see first?

[ZanatuBelmont]

You just received report on four patients with the conditions listed below. Who do you see first, second, third, and fourth? Why?

Patient A: Anal fistula - 70 y/o male - bedbound.

Patient B: Colostomy AND orifice are expelling feces (fistula suspected) - 90 y/o female - bedbound.

Patient C: Severe hypotension when ambulating - 40 y/o female - bedbound.

Patient D: Just underwent a TURP procedure - 50 y/o male - bedbound.

[Daytonite, BSN, RN]

1. patient d: just underwent a turp procedure - 50 y/o male - bedbound.
   
   • see first since they just had a turp. turp is a surgical procedure that could have the following complications: hemorrhage, urinary retention and incontinence. other complications include infection and impotence. if the patient had a general anesthesia they need to be monitored for breathing problems, hypotension, thrombophlebitis in the lower extremity, fever, fluid and electrolyte imbalances, surgical pain, nausea and vomiting. they will have a foley catheter with continuous saline irrigation that will be bloody colored and need monitoring.
     
   • http://www.surgeryencyclopedia.com/st-wr/transurethral-resection-of-the-prostate.html
     

[*]patient c: severe hypotension when ambulating - 40 y/o female - bedbound.

• monitor their blood pressure to see that it has returned to normal now that they in bed.
  

[*]patient b: colostomy and orifice are expelling feces (fistula suspected) - 90 y/o female - bedbound.

• assess for incontinent bowel movement and provide cleaning as necessary.
  

[*]patient a: anal fistula - 70 y/o male - bedbound.

[canoehead, BSN, RN]

D- look to see color and amount of urine/irrigation output, and general color/mentation, (from the door) Do this assessment hourly.

C last vitals OK? look to see if she's awake, if not move on to B, then come back.

If awake do general assessment/history trying to find a cause and the severity. Put her on a cardiac moniter ASAP and do postural vitals, recording EKG each time. Also glucose if that hasn't been ruled out as a problem

B check for need to be cleaned, mentation, skin breakdown, pain, vitals

A general look from the door (why is he bedbound? that might bring up other concerns)

D More through assessment including vitals

A complete assessment

Start again with C.

IRL a look from the door can happen in 5 seconds or so, just smile and wave, say "just checking, anything you need?" It makes patients feel more secure, and you get more information to prioritize with. I would bet money that my IRL answer doesn't coincide with the NCLEX answer.