Prioritizing patients....

[neuronursein06]

Random question- my med surg instructor told us to come to clinical on Tuesday "telling me how you would prioritize 4 patients," without giving us scenarios on a pt in pain, one who's EKG is abnormal, etc. How on earth do I tell her how I would prioritize if she didn't give me scenarios....

[jessnurse05]

It sounds to me like she's trying to give you a real life scenario. If you were working on the floor then you would only get a little bit of report and then decide what pt to see first. I go by ABC's, if anything is wrong with those, I see that pt first. If the EKG was abnormal then I would check them to see if they were having any symptoms. Then I would probably see a pt having pain, first checking to see when they had their last med, and what is due so you can tell them when you assess their pain. After that if all the pts are stable I try to manage my time, usually seeing the pt I know is going to be more difficult first (eg: pt has the most problems, or has given the last nurse a lot of trouble), but sometimes saving that pt till last, if I know that the other ones will only take a couple minutes to assess.

I hope this helps

Jessica

[traumaRUs, MSN, APRN]

I agree with Jessko - you always prioritize on the ABC's: first you look to ensure airway patency or the lack thereof, then proceed down to "is the patient breathing?", then onto circulation, then disability or neuro deficits, etc..

Does that help?

[Antikigirl, ASN, RN]

Welcome to the school of hard knocks! When I go into work, I have no clue what my patients are going have going on! So it is a lesson in real life nursing...and scary to boot! LOL!

Okay...basically if I was to go into this assignment being blind...remember your CPR's ABC's! That really helps get the priority list going strong! Patient with Airway or breathing difficulties are a strong priority, as well as heart conditions...totally not the rule for sure (heck, a screaming patient with abdominal pain will sure as heck tell you they are a priority..LOL!), but that basic mneumonic can help get your thinking cap going!

Pain issues are also high on the list, and you can't just pop a pill or give a shot either! You have to assess, make sure you aren't covering symptoms with meds (or the shift before you), new pain, increased pain, intermittent pain....the whole bit. Dependant on a person doing the assessment can be quite long (especially non verbal, very young or very old patients, or non English speaking patients!).

Patients with a change of condition during your shift or the last is another high prority patient! To me it is a red flag saying 'somethings brewing!'...and I like to stop those or get help for that fast before it boils over or explodes!

Okay so you have these aspects and more...then you can't forget your basic care needs too, you med passes, you VS, your transfers, your charting, your communication time..the list goes on...and something each person does differently. I think your teacher is trying to let you know this lesson, and the fact you just NEVER know what will happen once your feet hit that floor!

(I find finding the reason behind an assignment helps understand why you are doing it!).

Good luck...other people with have other prioritys they do, and it is also very dependant on where you work, what kind of area you are in, type of patients, if you have support staff, and so on :).

Okay I was typing this when the other two responded! GREAT MINDS!!!!!!!! :)

[HyperRNRachel]

ABC's first, then the patient with the most equipment or IV meds hanging.