Prioritizing Nursing Care Women's Health -Help Please

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Hello all, I am having a tough time figuring out the order to assess these patients in & am wondering if anyone would be willing to shed some light on the situation for me.

You have been assigned the following patients for the night.

Ms. Smith: Hospital day 1 (HD1): 16 year old woman admitted last night for PIH at 32 weeks gestation to stabilize BP. Is on q8 hr IV Labetalol doing a 24 hour creating urine collection. Last BP 200/101. Her BP on admission was 230/110.

Ms. Ortiz: Day of surgery (DOS): 50 year old woman 2 hours post-op abdominal hysterectomy for menorrhagia and fibroids on a morphine Patient Controlled Analgesia (PCA), pulse oximeter, and 2L non-humidified oxygen via nasal canula.

Ms. Linden: HD 2, 32 year old woman who is not pregnant. Hospitalized on IV antibiotics for PID. Last temp 2 hours ago was 38.7C.

Ms. Douglas: HD4, 30 year old woman hospitalized with preterm premature rupture of membranes (PPROM) at 28 weeks. Last temp 2 hours ago was 36.7C.

1)Which patient would you assess first, second, third, and fourth? What was your rationale for this order?

2) List the 5 priority assessments you would make for each patient when in the patient's room. These assessments should reflect knowledge of the underlying problem.

This is what I'm thinking, but it's a tough call -both ms smith & ms douglas seem to need care asap.

#1 Ms Smith- Pregnancy Induced Hypertension, Severe preelampsia? if proteinuria >/= 2 g; at risk for seizures, CVA, DIC, renal failure, hepatic rupture.

If no proteinuria, she's still at risk for HELLP syndrome; risk for hemorrhage, pulmonary edema, hepatic rupture.

High risk pt! Frequent assessment q 15 min for headache, blurred vision, R epigastric pain, blood pressres, may need to deliver--> fetal distress

PRIORITY DX: Risk for injury, Deficient fluid Volume?, Anxiety

#2 Ms Douglas- PRROM

Risk for infection r/t loss of protective barrier. Highly susceptible to infection!

Monitor for signs of Chorioamnionitis.

Mother- Risk for injury

28wk fetus- risk for injury: prolapsed cord

May need to induce labor

#3 Ms Linden

#4 Ms Ortiz?

Ahhh! I'm not sure. I've changed the order so many times. This is not a good sign for me. Please help.

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What order would you assess them?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

I would assess in this order:

  1. Ms. Smith
  2. Ms. Douglas
  3. Ms. Linden
  4. Ms. Ortiz

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