Prioritizing patients

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New member here, so I apologize of this is the wrong section to ask this question. I've been working on case studies for hours now, and I can't decide on this question.

"You are caring for the following 5 patients. Which one would you see first and explain why?

  1. 42 year old with cirrhosis of the liver with PTT 78, PT 49, INR 4.5, Platelets 45
  2. 25 year old with sickle cell crisis complaining of generalized pain 10/10. Hemoglobin 8.2 and Hematocrit 26.4"

I eliminated three patients, but I'm so burnt out right now that I can't choose between the two. I was leaning towards the patient with sickle cell, but the labs for the first patient are all really alarming, too. I really appreciate any and all help. :)

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Who are the other 3 patients

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Yeah ... please tell us the other patients... (:

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I'd see the SCA kid first, treat her pain or delegate someone to get her medicated, because unless the other guy is bleeding (and he might not be yet; you don't say he is) he isn't presenting me with anything that says, "Immediate nursing intervention needed!"

He will probably be bleeding pretty soon, granted-- one good sneeze and he'll bust those esophageal varices to kingdom come, and then it will all hit the fan. But your SCA patient is in "worst pain ever" right now, and from what we know about SCA, she is in agony. So get her medicated and settled down, she can rest, and you can settle in for a long messy siege with the GI service for the cirrhotic.

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Out of those two I'd say sickle cell crisis. Their pain is AWFUL. And as for cirrhosis pt... if there isn't anything currently going on with them, treat the other patients pain and keep an eye out for bleeding in the cirrhosis patient.

But I am curious as to your other three patients. Always remember ABCs, and always think about what is going to kill your patient first.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Looking at these two left. They both have chronic issues but only one right now says has ACUTE 10/10pain. I'd treat the sickle cell pain first. while those labs for the cirrhosis patient are horrible it doesn't mean they are bleeding right now

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The other three had VERY minor problems. I used the process of elimination and it was definitely between these two patients. I was leaning towards the sickle cell patient mainly because of the pain, but I just wanted to make sure. Thank you all very much!

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I know this a late response, but the sickle cell pt should be seen first. The H&H is terrible and according to the ABCs that could be detrimental to all ABC. As aforementioned, the other pt is not bleeding yet so I would choose to see the sickle cell first, act swiftly and go see the other pt. In addition, pain activates the sympathetic outflow, which eventually which activate alpha 2 receptors and increase platelet aggregation, which eventually can cause clots if the pain is not controlled quickly.

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Couldn't you also use acute vs. chronic to answer this question?

Even though the disease process of sickle cell is chronic, the crisis is acute. The cirrhosis patient is chronic in stable condition.

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Specializes in Family Nurse Practitioner.

Using my still trained on NCLEX brain, I would see patient #1 first because it is a CIRCULATION issue. I would check to make sure they aren't bleeding and notify the doctor of the abnormal labs. The PT/INR are high, but the platelets are critically low and the patient would definitely get a transfusion if they were a surgical patient. The cirrhosis issue is there to distract you. Cirrhosis is a chronic issue and unless ammonia is high and affecting their mental status (which isn't mentioned) this aspect of the patient's presentation does not require immediate attention. Then I would take care of the sickle cell patient. Pain is considered a psychosocial issue on NCLEX, unless it is sudden onset or unexpected pain. In the case of a sickle cell patient in crisis, they are generally in severe pain at all times that is hard to completely relieve. In the real world, I would get some IV dilaudid for the sickle cell patient first and then take care of the other patient.

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Specializes in Hospital Education Coordinator.

I think #1 would be first because NCLEX considers pain a psychosocial issue, not a life-threatening issue. The POTENTIAL for #1 getting worse is greater, while #2 cannot get any worse. You really do not know if #1 is bleeding or not because you do not know what his/her labs were like earlier.

However, would like to know about the other three patients.

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#1, because it's asking which patient to see first, not who you'd treat first. If I got report on those two patients, I would want to check on patient #1 first, to check VS, LOC, and make sure there's no bleeding.

That being said, if the first patient was stable I'd give pain meds to the sickle cell patient before I did anything for the cirrhosis pt.

On questions like that I'd ask myself who is the most likely to code. On the NCLEX they'll throw in phrases like "worst pain ever" to try and distract you. Sickle cell patient do have really horrible pain, but pain is never life threatening.

Just my two cents.

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