Prioritization question - need help with rationale

  1. Hi! I'm trying to find out which is the correct answer to the following prioritization question:

    A 30-year-old client is brought to an emergency trauma center with a hand injury from a nail gun sustained while remodeling an old barn. there is a strong odor of alcohol and the client admits to having three beers during a 3-hour period. Which assessment findings are most important for the nurse to evaluate FIRST?

    a. blood type
    b. time of last voiding
    c. current blood alcohol level
    d. date of last tetanus immunization

    I would also appreciate your rationale. Thank you in advance!
  2. Visit Crobert profile page

    About Crobert

    Joined: Jan '13; Posts: 4; Likes: 1


  3. by   Esme12
    Welcome to AN! The largest online nursing community!

    We are happy tp help with homework but we won't do it for you.....we ask that you tell us what you think and why first,,,,then we can help you understand what would and would not be important and why.
  4. by   PurplePRN
    Am I the only brand new student (week two! LOL) who has NO clue what they are doing yet who got all excited trying to solve this? LOL! I'm going to PM you what I think it is and my rationale Esme, if that's okay? Because this will bug me ALL DAY. I don't want to annoy you though.................
  5. by   Esme12
    it's fine....or post it here if you want I'll answer....
  6. by   PurplePRN
    Ha! PM'd. I'm not THAT brave yet! Esp since I haven't learned anything yet. Thank you SO much!
  7. by   Esme12
    LOL.....then PM me...
  8. by   Stephalump
    OP, are there any you think you can eliminate right off the bat?
  9. by   Crobert
    I think interventions a and b are not important for the moment. My struggle is to choose between c and d as my first intervention if I ever find myself in the situation to assess an inebriated patient. I know that nail gun incidents can lead to tetanus infections and I would want to know whether my patient has been immunized and how long it has been since he has been immunized (to determine if he is still protected by the vaccine or not). But then, wouldn't I want to know his current blood alcohol level first to help me make a decision as to my next interventions? I know I cannot give the tetanus shot to a person who has been consuming alcohol, for that might lead to a dangerous systemic reaction. So, I guess, I'm a bit confused at to which of c and d I should do first.
    P.S. Also, I have not received any private message. I would prefer that we discuss this problem here on the forum so I can understand better how the prioritization has been done.
  10. by   nurseprnRN
    I have no idea where you would have learned that an elevated blood alcohol level would lead to a "dangerous systemic reaction" of any kind if tetanus toxoid were given. Trust me, people who are roaring drunk come in with trauma and get their tetanus all the time.

    a. blood type : not gonna bleed that much from a nail gun injury to the hand
    b. time of last voiding: why would this matter? If he's well enough to tell you he had three beers, he's well enough to tell you if he has to go again.He will soon, anyway.
    c. current blood alcohol level: this will make no difference in his treatment for a nail in the hand; it is not an emergency and will not require general anesthesia so he can wait a little bit if he isn't cooperative enough for it now
    d. date of last tetanus immunization: always, always. Dirty penetrating wound, tetanus is nasty, people always forget when they had the immunization last. Standard of care.
  11. by   Crobert
    GrnTea, thank you so much for taking the time and trouble to provide me with rationales for why we would or would not do the activities listed under my question. As for the possible systemic reaction to the tetanus toxoid in persons with excessive alcohol consumption, I found the information on the website of the Centers for Disease Control and Prevention (there is a general immunization recommendations document there).
  12. by   hella_RN
    Blood type. Rationale - to give type specific blood if the patient needs transfusion since he is bleeding. Blood alcohol level doesn't really help much, tdap can wait, date and time of last voiding might be inaccurate since the patient might be too intoxicated to even answer the questions correctly.
  13. by   Ciale
    Yeah, blood type but only because I'm applying the "Test Strategy Rules". They only put pertinent information in the question so you have to ask "why do I care if he's been drinking?" Alcohol is a blood thinner and while I don't think a nail gun injury to the hand is going to require a transfusion, the question is setting it up that way. In the real world however, none of this are particularly important assessments to make other than the tetanus question. In fact, I'd say asking him if the wound was intentional would be the priority question and if he had plans of hurting himself or others.
  14. by   Stoogesfan
    I would go with d. Tetanus would be the highest priority at the moment.

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