Prioritization in Disaster Nursing

[souleater11]

Guys, Below is an trial sample of kaplan Qbank. I'm confused about the Prioritization of Disaster Nursing.

Should I take the people that are most critical unstable or

should I priorize the highest chance of survival patient ?

My Answer was (1) because the patient can walk away from the disaster area.

The home care nurse visits a client in a large apartment complex. During the visit, the area experiences a major earthquake. Which of the following clients should the

nurse see FIRST?

1. A restless client with a rigid abdomen and absent bowel sounds.

2. An unconscious client with left-sided tracheal shift from midline.

3. A client complaining of excruciating pain with an obvious deformity of the left leg.

4. A client clutching her chest and complaining of severe chest pain.

Strategy: Determine the most unstable client.

(1) likely has injuries to abdominal organs, resulting in hemorrhage and severe circulatory compromise and requires emergent evaluation; airway and breathing take

priority

(2) CORRECT--first sign of a tension pneumothorax; airway and breathing take priority

(3) assess for neurovascular compromise; client with breathing difficulties takes priority

(4) circulatory problem; airway/breathing problems take priority

[June2012]

I think if we choose the most unstable it would be no.2 .

But i m also confused on picking the highest chances of survival patient .

I hope somebody will make us clear on this

[MissRnToYou]

I was confused between 2 and number 4 because chest pain indicates an MI. I think at the end of the day, I would have chosen number 2 because the patient is most critical.

[JENURSE03_RN, MSN, DNP, RN]

2 and 4 are most critical, 2 would be the answer because it is the most critical Airway vs. chest pain.

Here is another example that I came across. If a patient had a severe chest pain vs. a patient with a 3rd degree burn on the face/stomach. It would be the 3rd degree burn to see first because of Airway as well. I hope this helps.

[Inori, BSN, RN]

You can get to the correct answer applying rules of ABCD (airway first). or prioritzing actual over ri. also take a look at specifically how they do triage and color coding (red, orange,yellow, green, black) this is basedon survial and ah best use of limited personelle and resources. Medical Triageing: Medical Triage (Color Tags, START) Terminology by MedicineNet.com

TACTICS TO PRIORITIZE:

ABCD: Pt 1 gapsing for air, sternal retractions, pulse ox 85 etc, Pt 2 complains of pain, Pt 3 needs bedpan, PT4 is bleeding and his bedding is soaked, (TOPIC: priority>ABCD the PT 1 is respiratory so see him first ..ANS: T1 is more in danger of dying in next few mins while PT 4 is bleeding but is not as high of priority of cant breathe.

Maslow SAFTY need especially- always put the basics first, food, water, safty then higher level needs like love and pyschosocial. Sometimes questions give you a few pts all are about the same except one is going to hurt himself if you dont immediately do something. *thats's who you see*

STABILITY: several pts on floor all have needs, you see the pt who is most unstable first. such as post op, has conditions that will rapidly change. EX: pt 1 - 5 hrs postop for abodinal surgery, Pt 2 newly admitted with multiple injuiries from MVA, pt 3 alzhemiers with parkinson. ANSWER: see the newly admitted pt first because chances are he's teh most unstable and has probably a few more unknown problems from the accident that will come up. Everyone else you know whats wrong with em and why they're here and can predict what they'll need from you.

Physical vs. pyschosocial - always put physical first unless its a pysch type question.

Assess or Implement -- we always assess first then depending on what problem is = we implement.

Actual Problem or Risk for= always put actual problem first.. this i one where you have proof of it not maybe possibley could be would be etc etc