Prioritization interview question advice

[archemichael]

Referencing the following link:

https://allnurses.com/school-nurses/school-nurse-interview-794566-post7005063.html#post7005063

How would you answer the following question:

You walk into your clinic and a child comes in having an asthma attack at the same time another comes in with a major nose bleed, a parent is at your door and faints at the sight of blood in the hallway, the child that was already waiting for you starts throwing up......what order and how do you take care of each situation happening?

Following AHA guidelines with CAB, would you assess the major bleed as priority as it is a circulatory issue and then the student with asthma attack?

Please advise.

[KelRN215, BSN, RN]

Which of these people might die if you don't tend to him first? The asthmatic is the priority. Unless the nosebleeder is a hemophiliac or a child with cancer with a platelet count of 10K, he'll clot and be just fine. You will likely know who your asthmatics are and have rescue inhalers available within reach, if your school doesn't allow the children to carry them on their person. Tend to the asthmatic, while doing so tell the nosebleeder to grab a tissue and hold pressure and direct the vomiter to the bathroom or the trash can. Once the asthmatic has used his albuterol inhaler or you have him set up with a neb and he seems to be improving, you can move on to the parent. You know the parent fainted from the sight of blood, so she'll probably be more embarrassed than anything when she comes to. I doubt 911 will need to be called for anyone in this case but if it does, it's probably for the asthmatic. Unless the vomiter has hydrocephalus with a VP shunt, he's unlikely to need any kind of urgent care. Most schools send kids home for vomiting so once things are settled with the rest you can call the parent to pick him up.

[ParalyticAgent]

Just to be clear, the C for CAB is to check for a pulse and the across the room survey is for major hemorrhaging, not a major nosebleed. Even if the bleeding is substantial, they will be okay while you assess the airway and breathing of the asthmatic.

[archemichael]

Had the job interview. Hope it went well. I will keep you guys updated. Thank you for all your valuable input.

[Flare, ASN, BSN]

I'd check out the asthmatic first - usually the asthmatic can get stabilized with a few puffs of an inhaler and sitting for a moment.

Next would be passed out parent. Did they hit their head, any LOC? is this 9-1-1 worthy or a garden variety syncope over seeing something icky.

Nose bleeds - no matter now scary they look to the staff are rarely life threatening bleed out situations (maybe if a concurrent trauma is involved, but since the student walked into the office in this scenario, we'll assume this person just has a big clot looming up there). So that being said - with all the rest going on, i'd probably sit that child down with a box of tissues and give them my normal instructions (someone already posted - pinch just below the bone and squeeze for a few minutes. Then i usually have the kids give a gentle blow to get the clot out)

The vomiting child will get their very own trash can or escorted to my bathroom (whatever is easier at the moment) and when i have a second if i haven't already i'll call home or better yet, i'll call for some help to manage all this action and someone else can call home and anyone else i need.(because i may also now need a custodian for my floor too )

[MendedHeart]

I'm curious- what's the rationale behind a vomiting person laying on the left side? I've not heard that outside of cardiac issues.

I think it's due to the lung anatomy. The right side is straighter than the left and is most often the site of aspiration.