Which pt is priority?

Nursing Students Student Assist

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OK...so tomorrow I have two pts. Pt A readmitted after being d/c for abdominal pain and diarrhea. Pt's rbc, hgb, htc, plt and iron are all VERY low, pt dx with enteritis/colitis and thrombocytopenia and anemia. Pt B admitted with chest pain. Pts rbc, hbg, and htc are low but not as bad as pt a. Pt has had not further chest pain since admission and was sent to cath lab, results not back yet. I chose pt A as my priority pt simply because of the bleeding risk with the thrombocytopenia, the n/v and diarrhea put the pt at risk for dehydration and because with the low h & h the ineffective tissue perfusion....am I wrong? Any input would be great!

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I understand you're thought process however, I hear my instructors voice in the back of my head saying "will they still be alive when I return"...(I'm paraphrasing).. so with this in mind, my thoughts are your cardiac patient...back to the ABC's and verify no SOB and view lab reports.....then patient A.

I could be totally out in left field...but just because patient B hasn't exhibited any chest pains...that still is a priority in my book.

HTH....GL!

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aaagghhh!! I know I know...I can hear my teacher too...anything heart related is priority...and at first I was going to go with pt B, but upon looking at labs and because no other info for pt B was available yet, I went with A. But I just have this gut feeling that she will tell me it is B. I am really struggling with prioritizing my pts. I really hope I get the hang of it soon. Sometimes it really makes me feel retarded that I didn't she what she wanted me too. :confused: I just keep telling myself it comes with practice and learning more and more...Thanks for your input!

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whoops...I mean see what she wanted me too! :)

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Specializes in Cath Lab/ ICU.

The results of the cath lab are immediate, lol. And they could very well be unstable awaiting CT surgery, or have worked on the left side, and need fixing on the right the next day..

Basically, there is not enough info provided. And remember, anemia can cause chest pain, if they have a lesion and are anemic then there is even less O2 delivery,

So, vitals would be a good start. And specific lab values. How low were the plts? 100? 20?

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aaagghhh!! I know I know...I can hear my teacher too...anything heart related is priority...and at first I was going to go with pt B, but upon looking at labs and because no other info for pt B was available yet, I went with A. But I just have this gut feeling that she will tell me it is B. I am really struggling with prioritizing my pts. I really hope I get the hang of it soon. Sometimes it really makes me feel retarded that I didn't she what she wanted me too. :confused: I just keep telling myself it comes with practice and learning more and more...Thanks for your input!

Try not to get upset with yourself...and stress...easier said then done but it only makes things worse! Take deep breaths and give yourself words of encouragement. You can do this, and you will be great! I think you've mastered the first step, you care!

GL!!

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The results of the cath lab are immediate, lol. And they could very well be unstable awaiting CT surgery, or have worked on the left side, and need fixing on the right the next day..

Basically, there is not enough info provided. And remember, anemia can cause chest pain, if they have a lesion and are anemic then there is even less O2 delivery,

So, vitals would be a good start. And specific lab values. How low were the plts? 100? 20?

Interesting - good point!! So who would you prioritize?

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OK well when I looked in the computer, the cath lab reported that they had finished and that report was to follow but nothing had been entered by the time I left, so things might be different tomorrow am when I go back. Pt A's labs were rbc 2.59 hgb 7.5 htc 22.7 and plts and iron level of 16 and vitamin D of 7.2. 66 vitals were T 98.6 P. 100, R 18 BP 159/81 and O2 100 Pt B's labs were rbc 3.53 hgb 10.6 htc 31.7 and normal plts of 209 vitals T. 98.6 P 65 R 16 BP 144/62 O2 96 Neither pt has any abnormal electrolyte levels.

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Lord I can't type today, pt A's plts were 66

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Specializes in Cath Lab/ ICU.

Clearly pt A in this case.

(what a difference lab values make :) )

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Thank you soooo much for your input. I had such a bad week last week and I just started this rotation with a new teacher and last week I was like a fish out of water trying to figure her out, I just wanted to make sure I was on the right track this week. I really really appreciate you giving me your opinion! :D

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