You, an RN, are assigned the following patients for total care today. Report is over at 0720. Prioritize these four patients and provide rationale for your decisions.
401 Mr. A: 65 year old, same day surgery admission at 0630 for a herniorrhaphy this morning. He's been NPO since midnight. The admission is complete and the OR permit is signed. His temp was 97.8, pulse 78, respirations 20. BP was 132/68. Pre-op med is due at 0800.
402 Miss B: 71 year old, diabetic with a left femoral-popliteal bypass, first post-op day. Temps during the night were 99.2 and 99, pulses 88 and 84, respirations 20 and 18. BPs142/88 and 144/88. Pedal pulses are 80 and 84 on the right and not palpable on the left. The left foot is somewhat cooler than the right, but there is good capillary refill. Her dressings are clean and dry. She has an IV of D 5 1/4 NS at 100 ml/hr with 320ml to go and remains NPO. She has a foley that drained 125 ml of concentrated urine since midnight. She is on sliding scale insulin. Her glucometer check was 240 this morning, and she got 10 U of regular insulin. She has an IVPB antibiotic at 0800.
403 Mr. C: 42 year old, had a gastric resection and returned from PAR at 0430 yesterday (27 hours ago). He has a Salem sump pump on low intermittent suction that drained 675 ml of bloody/green drainage during the night. He has an IV of lactated ringers at 150 ml/hr with300 ml to go. He has 2 units of blood on call. Hourly BP's have ranged from 112-120 over 64-70. 0600 BP was 112/64. Pulse has been 80-98 and was at 98 at 0600. He was cathed for 250 ml at 0400. He's been turned q2h. He coughs and deep-breathes poorly. He had Demerol 75 mg IV at 0345. His dressing had a large amount of sero-sanguinous drainage when it was changed at 0400.
404 Mrs. D: 59 year old, with lung cancer, had a scalene node biopsy yesterday afternoon to check for metastasis. She is to be transferred to her home by ambulance this morning at 0830. She has 0800 and 0900 meds. She had a poor night, developing a new onset of SOB with O2 sats at 0200 of 94 % and at 0600 of 90%. She was placed on O2 at 2 L at 0200.
Okay so here goes nothing...
1. Mrs. D in room 404 - Pt has a new onset of SOB and O2 sats have been dropping. I would consider her first priority due to breathing.
2. Miss B in room 402 - Pt is lacking peripheral pulse after surgery is displaying signs of decreased circulation. Also, foley has only drianed 125 mL in about 7 hours, definitely having perfusion issues. Temp also elevated.
3. Mr. C in room 403 - Pt's vitals appear stable. Will probably need dressing change and possibly pain meds.
4. Mr. A in room 401 - Pt is stable and just waiting for pre-op med and OR.
This is a very interesting topic and I know the struggles of trying to figure out which is "more" correct. Did you ever find out which is the most correct?
KSonosy
1 Post
This is a very interesting topic and I know the struggles of trying to figure out which is "more" correct. Did you ever find out which is the most correct?