Prioritisation of care question

itsmejuli · Aug 20, 2010

What order would you see them in? What is your rationale for each?

Mandychelle79, ASN, RN · Aug 21, 2010

Patient 1: Medications due... IV Antibiotic- would do this one last because you have a certain amount of time before and after the dosage time that is still ok to give it (30 mins to an hour each way, depending on facility policy from what I have seen)

Patient 2: Experiencing active nausea and vomiting. Have non licenced staff give patient emesis basin, lower on the priority list

Patient 3: Behavioural problems, aggressive. med priority- as long as patient is in safe location and not able to harm self or others at that moment in time. if patient becomes safety threat, then would jump to top priority

Patient 4: Hypertensive patient, currently experiencing headaches and feeling light-headed. would see second. current set of vitals, make sure safe.

Patient 5: Diabetic, currently has a low blood sugar level.- Top priority, depending on bs level and if has already been treated and waiting to

Remember that you are "usually" not alone, and I would be asking for help if I had all these things happening at once. The aggressive patient may have a rapport with another staff member and they can help defuse the situation ( we use this a lot on our unit).

KneKno · Aug 22, 2010

Agree with PP. I'd be juggling #4 and 5. How high is the BP, how low is the glucose? That'd tell me which way to go first. If diabetic is responsive, can someone else take them a snack? Any protocols in place for treatment of hypoglycemia? (D50 if unresponsive). Is the BP high enough to warrant a rapid response, or do you have prn orders to medicate?

K.P.A. · Aug 22, 2010

Do not read into the question. Go with what you are given. Weigh my advice carefully...I'm just beginning my final semester :-)

5,4,2,1,3

Based on information given and "safety first".

5. Diabetic is the most likely to die in the shortest period of time.

4. HTN pt may die but if he doesn't stroke...it's gonna take longer.

2. NV is common, seldom fatal, and most people have experienced it.

1. Meds usually fall in a 1-2 hr window, depending on facility.

3. Aggressive pt...it may prove uncomfortable for the pt but in context it's an issue for security until there is enough time to focus on him.

azhiker96, BSN, RN · Aug 24, 2010

Hi all,
Quick intro: I'm a first year student nurse in Sydney, Australia.
Just entered second semester and have really been enjoying the degree so far.
Can't say that about my previous business degree.
Anyway, given the following scenario how would you prioritise these patients?
What additional information would you need to know? How would you act / What would you do? Why?
Patient 1: Medications due... IV Antibiotic
Patient 2: Experiencing active nausea and vomiting.
Patient 3: Behavioural problems, aggressive.
Patient 4: Hypertensive patient, currently experiencing headaches and feeling light-headed.
Patient 5: Diabetic, currently has a low blood sugar level.

I'd start with the two who are currently symptomatic. First #4, this could be early signs of a stroke. Needs an assessment and possible call to MD. Then #2, administer anti-emetic to help prevent aspiration. Airway is pretty important. A snack for #5 to address low bg, IV abx for #1 to keep fighting their infection, then sit and talk with #3 about their complaints.

Of course, if low blood sugar became diaphoretic or confused they would get boosted up. For now an aide could take a snack to them.

Also, if aggressive became combative then it's time to call code grey and get security and all my friends there to discuss options with the patient.