Question on priority order

[LHC123]

I have to put these 5 in order of priorities and hopefully someone can guide me in the right direction. All I hear are ABC's in my head.

a- pneumonia with 2 rounds of treatments, and O2 at 93%

b- 30 minutes post op anesthesia

c- post op CABG pain at site

d- discharge no ride

c- discharge teaching.

A and B, I keep wanting to put B first, then I go back and forth between B and A, all I know is emphasis was placed on A (airway), B (breathing), and circulation. I keep favoring B over A for priority. Can anyone assist me?

Leah

[NewMurse1014]

I think there's a difference between the NCLEX world of nursing vs. the real world. Yes, ABC is the general guideline, but in the real world we also need to consider other things: are the findings expected or unexpected? Which one will kill the patient first/the most unstable finding? With the limited information given, it's hard to prioritize. Is patient A having SOB? O2 sat can be misleading sometimes. How does the lung sound? How long is patient C post-op? Is the pain at the site new or old? How does the site look like? The answers can alter the priority of the patients.

[LHC123]

Unfortunately, that is all we were given in order to put them in priority. We were given just "think of ABCs", and don't read anything else into it. I am the worlds "queen" at wanting more information and reading into it.

[emmjayy, BSN, RN]

I'm just a student too but I'll take a little stab at this because it's exercising my brain. I would put the patient who's 30 min post-op and had anesthesia above the pt with an O2 sat of 93%. The post-op patient is going to be at high risk for bradypnea, hemorrhage, shock, hypothermia, etc. The patient with pneumonia isn't in an ideal place but it's not like their O2 is in the 80's or something like that.

[NICU Guy, BSN, RN]

a- pneumonia with 2 rounds of treatments, and O2 at 93%

Is it stating the O2 saturation is 93% or the patient is on a ventilator with an FiO2 of 93%? There is a big difference in prioritization between the two.

[LHC123]

Just patient with pneumonia who has already been given 2 treatments, and O2 at 93%, no vent at all I assume. She said don't read what isn't there and made no mention of vent.

[NICUismylife, ADN, BSN, RN]

I think your gut is steering you correctly. I'd put B as the first priority. Post op patients need vitals every 15 minutes because they can deteriorate quickly and experience a variety of complications related to both the surgery and anesthesia. One of the biggest risks is respiratory depression and inability to maintain an open airway, so B is actually an Airway/breathing issue as well.

[Kuriin, BSN, RN]

Do you think A is expected, given that this patient has pneumonia? What are some possible complications in a fresh post-op patient? What are expected things post-op?

What you have is almost correct. D and C are definitely the harder ones (but no ride should be a discharge planner thing) whereas teaching is very important.

[AliNajaCat]

Part of the point of assignments like this is to give your faculty an idea of how you think, when you tell your rationales for your rankings.

That said, though, the postop is at greatest risk for problems, probably from an airway issue, but also because he could wake up wild and hurt himself (this will change as he wakes up better).

You DO have to specify what that "O2 is 93%" means. If it's the % of O2 the patient is inhaling , that's not the same as an SpO2, peripheral oxygenation saturation (of the hemoglobin). The difference makes for considerable differences in decision-making, but I'm going to assume that it's SpO2. 93% ain't great, but it's not as acute as the postop.