Prioritization Question

[CollaborateRN]

Mr. Charles is a 59 year old patient with a history of emphysema. The patient smokes 3 packs of cigarettes per day, drinks alcoholic beverages 4 times per week, consumes a high fat diet, and leads a sedentary lifestyle. Over the last two days, Mr. Charles has been complaining of increasing shortness of breath, periods of dizziness, and fatigue. Prioritize the following list of activities you would use to safely manage this patient and explain the rationale for each.

1.Request a nutritional consult

2.Request a psychiatric consult

3.Do extensive blood work analysis

4.Implement a falls precaution protocol

5.Schedule early social work intervention

6.Perform a complete physical examination

7.Attach the patient to a cardiac monitor and pulse oximeter

[WntMorCNA]

Are you wondering an answer to this question? Btw... what is the exact order they should be in? My guess would be (probably wrong though)... 6, 3, 7, 5, 1, 2, 4. I was thinking about the nsg process and Moslow's Hierarchy to answer the question. ASSESS FIRST! Correct me if I am wrong on the order or comment if you think differently!

[skittlebear]

is this your homework?

[itsmejuli]

If you follow the ABCs and Maslow's hierarchy of needs you shouldn't have a problem with this.

[Pedsnurze]

6,3,7,1,2,5,4 need labs & physical info before able to implent any others.

nut & psych- so know what needs to be doing - are you able mentally to do so

social- if mentation intact then need to know do you have the means and check up on precautions that were implented.

So nowbe sure to post the correct order as soon as you get them.

[CollaborateRN]

is this your homework?

This is a discussion question, that I have to answer before a specific deadline regardless of input from allnurses.com members.

I'm just looking for any pointers from people who are willing to help... to see if there is anything I missed, or other ways of looking at the situation.

[CollaborateRN]

I wish post the official answer as soon as it is posted in our class. It usually takes couple of weeks or more for that to happen - although, we get only four days to answer three questions like this one.

I've noticed - that even with our best rationale for doing steps in a specific order - most students in the class do not get the exact same order the professor is expecting.

Can only do our best, right?

[CollaborateRN]

Thanks Juli - I'll remember that when I answer this question :)

[Daytonite, BSN, RN]

you are being asked to problem solve. use your problem solving tool--the nursing process. identify which step each of your 7 activities would fall on and which is most important at what time and who you are doing the activity for. this is how i would sequence the activities:

6. perform a complete physical examination - assessment

7. attach the patient to a cardiac monitor and pulse oximeter - assessment - would be deemed necessary when doing the physical exam

1. request a nutritional consult - intervention (independent) - address nutrition issue before safety

4. implement a falls precaution protocol - intervention (independent) - address safety issue

3. do extensive blood work analysis - intervention (collaborative) - after notifying md of any abnormal assessment data, md orders would be carried out. this would be part of the md's assessment, not the nursing assessment although we would be interested in the findings

2. request a psychiatric consult - intervention (collaborative) -if you feel a psych assessment is needed a physician's order is necessary and it is part of our management function to do that

5. schedule early social work intervention - intervention (independent) - in preparation for discharge

[skittlebear]

I would say:

6, 7, 4, 3, 1, 2, 5....but that is before I read Daytonites response. Now I am questioning myself, lol.

[CollaborateRN]

Thank you Skittlebear. That is exactly the reason why I posted the question here. Two nurses can prioritize differently using sound rationale. However, the instructor only accepts the prioritization order he/she thinks is best - based on the rationale the instructor believes is best.

Sometimes, I feel like it is a matter of making our best attempt. It seems like there is no way to guarantee that I have the right order - no matter how carefully I have prioritized.

[Pedsnurze]

you are being asked to problem solve. use your problem solving tool--the nursing process. identify which step each of your 7 activities would fall on and which is most important at what time and who you are doing the activity for. this is how i would sequence the activities:

6. perform a complete physical examination - assessment

7. attach the patient to a cardiac monitor and pulse oximeter - assessment - would be deemed necessary when doing the physical exam

1. request a nutritional consult - intervention (independent) - address nutrition issue before safety

4. implement a falls precaution protocol - intervention (independent) - address safety issue

3. do extensive blood work analysis - intervention (collaborative) - after notifying md of any abnormal assessment data, md orders would be carried out. this would be part of the md's assessment, not the nursing assessment although we would be interested in the findings

2. request a psychiatric consult - intervention (collaborative) -if you feel a psych assessment is needed a physician's order is necessary and it is part of our management function to do that

5. schedule early social work intervention - intervention (independent) - in preparation for discharge

like your pathway much better than mine. thanks 4 making me take time 2 think. i must slow down, speed can kill