Patient Priority

[chicklet74]

can some experienced nursing students or nurses help??? of the 4 patients below, which would you consider to have priority problems? i'm leaning toward the uti, but i'm not sure and keep going back and forth. please help!

1. 65 year old female admitted with nausea, vomiting, and diarrhea for three days. possible c-diff, contact isolation vrsa. 4 liter oxygen, nasal cannula. right leg amputated above the knee, left foot deformed. incontinent to bowel. alert and oriented x3.

2. 87 year old female admitted with uti, has anxiety, negative for c-diff, contact isolation mrsa. beside commode with assist. alert and oriented x3.

3. 94 year old female admitted with urosepsis, fell at nursing home abrasions to forehead and knees. dnr #2. 2 liter oxygen, nasal cannula. incontinent to bladder and bowel, complete care. alert and oriented to self.

4. 65 year old female admitted with shortness of breath, exacerbation of copd. standby assist to bedside commode, some stress incontinence. oxygen dependent on 3 liters, nasal cannula

[ashleepules]

I would've chosen the Cdiff pt, i'm just a freshman, so i wouldnt call myself experienced however, i thought to myself, hmmmmm, which one would die quickest with no intervention....the uti is serious, especially in elderly pts, but b/c its not a resistant organism it should be easier to control. Cdiff is horrible, pts can deteriorate very very quickly, and the fact that she is immobile, malnourished, and bowel incontinent with diffuse diarrhea, is a recipe for skin breakdown, which opens her up for another infection, which equals disaster. I would put the 94 y/o at priority 2 b/c of the sepsis from the kidney infection, she would deteriorate pretty quickly too, but her DNR status put her priority just short of Cdiff lady. The COPDer, well this is probably not her first rodeo, and you usually can get COPD pts under control pretty easily, if they have no complications. Just my opinion, i do not know how accurate it is, but i always love to see others train of thought, it gives me different perspectives to work from. Good Luck!

[epnurse0796]

I would love to see you figure this out! So here is a question to start with....

Remember your ABCs..... do any of your patient's fall into this category for treatment?

[epnurse0796]

Also patient #1 what history could she have that led to right leg amputation? Uncontrolled diabetes, impaired vascular? 4 liters of O2??

Patient #2 nothing really alerted me

Patient #3 remember that DNR does not affect your priority only the medical treatment if she were to code or plan of care for doctors and families

abrasions on head after a fall.... did she hit her head

The biggy is sepsis though, her body will be in a compensative state

Patient #4

COPD...airway

[Butterfliesnroses]

you will get more help if you tell us what you think :-)

[ashleepules]

Patient #3 remember that DNR does not affect your priority only the medical treatment if she were to code or plan of care for doctors and families

Thanks for that advice epnurse, i did not know that...now that i think about it, that was not the most ethical decision, huh?

[PinkNBlue, BSN, RN]

ABC's always... ALWAYS!

[MunoRN, RN]

ABC's are a good rule of thumb, but you have to remember that by definition a "rule of thumb" is a quick but inaccurate measurement. ABC's are a good starting point but you may need to dig deeper to break a tie.

Think ABC's but also think severity and potential outcomes. COPD is a threat to airway and breathing, but is fairly easy to manage compared to sepsis. Sepsis also threatens breathing and circulation, with circulation impairment being an understatement when it comes to describing sepsis.

Other than their activity tolerance and O2 requirements, it's hard to gauge the severity of #4's COPD and #3's sepsis. #1 clearly has risk factors, although it's hard to determine what their immediate threats are other than their apparently high O2 needs. What we do know is that a COPD exacerbation can be treated with something as simple as zopenex neb and solu medrol in the ED and the patient can sometimes go home without even being admitted. Sepsis on the other hand, is not such a quick fix and typically requires initial treatment in an ICU and claims far more hospitalized patients than COPD. #3 Doesn't exactly have the benefit of youth on her side either.