Orientation Issues with Prioritization

littlewingrn · Aug 30, 2011

Wouldn't part of your charting, after initial assessment, be interventions you implemented? Just assessing continually without actually doing anything is kind of pointless. I am fairly new myself, so I could be wrong....

Kyrshamarks, BSN, RN · Aug 30, 2011

I am going to play the devils advocate here. You fixed that problem and it took a bit of time by the soiun ds of it, which in itself is not bad but what if next door now you had another patient that also has a high BP...say 240/127? or is going into resp distress and a delay there could literally mean life or death? So before you treat the opne patient you need to see what the other patients are doing to be able to prioritize the care that you need to give and futrther more you need to document you assessment immediately so you do not forget anything that yoiu saw on that pt. Try to see your your nurse educator is coming from.

classicdame, MSN, EdD · Aug 30, 2011

this is a perfect example of issues new nurses have in trying to merge what was done in school (with ONE patient being discussed) vs. "real life". Work with the educator on how to prioritize your tasks. I can see where you thought you were doing the right thing, and sometime you DO have to stop midstream, but for the most part you need to get a fix on ALL your patients ASAP. Otherwise, they may not be assessed by anyone for a long period of time and that invites disaster.

turnforthenurse, MSN, NP · Aug 30, 2011

...Wait, she wanted you to chart everything before giving meds, etc? I was always taught that charting can wait. After doing the assessment I would have given her her meds. I also would have waited to contact the doc since your patient was on 4 different BP meds and see what that would do first (the docs at my facility would tell me the same thing...).

If you have other patients, you have to prioritize. We do reports at the bedside at my facility, so that kind of gives me an idea of how the patient is when I come on. I can do a quick mental assessment just by looking at them and also introducing myself to them, asking them how they are that evening and if they are in pain. I can tell if they are A&O, see if they are in any sort of respiratory distress and also see if they are hemodynamically stable (our patients are on monitors) just by looking at them. Also looking at what the patient is here for and how they were during the last 12 hours helps my prioritization. And also ABC's.

Isabelle49 · Aug 30, 2011

Your preceptor was clearly WRONG!

Roy Fokker, BSN, RN · Aug 30, 2011

I had a patient with a BP 170/107. I wanted to give her four morning
BP meds to see if I could get it down before contacting the Doc.
Background: Patient was 89 yo female, comfort measures, with intracerebral hemorrhage, BPs were trending high, but not that high...

(emphasis mine)

I think this is the key issue here.

The question is:

1. Should I treat this patient's BP of 170/107 with her morning BP meds STAT?

OR

2. Should I continue on to my other patients, assess them and return to this patient later and give her morning meds?

I'm not sure I can answer the OP with any degree of confidence just yet.

Yes, a BP of 170/107 appears high (given OP states pt. has a brain bleed and the BP has been trending high), but was the pt. symptomatic?

I think that would be my 'motivator' (along with added data on the BP trend).

If the pt. showed no major change in symptoms or no adverse shift in BP, I would probably wait, assess my other pts. and make sure they're ok before I returned to this pt.

cheers,

Simply Complicated · Aug 30, 2011

Yes, I do believe you should ASSESS all of your patients first, then treat the issue. If it's not emergent and needed done right then and there. But to say you needed to CHART on each patient before, I do not agree with.

She is kind of contradicting herself IMO. If she is saying the assessments are priority, than you should be assessing each patient first. Sounds like she is making the charting a priority, telling you to chart in between each assessment.

I always preferred to keep a clipboard or something with me. I would assess, and make notes so that I could reference them later when I sat down to chart.