Saturday, November 7, 2009

Which patient should have a priority?

What's the primary task of this scenario? Nurse A is assigned to step down unit where she is scheduled to work with 4 other nurses. She is scheduled to get the first admission. Currently the floor census is 8 patients. The assingnment:
NURSE A1)Craniotomy- three days post. surgery.fights out of bed. He has one to one sitter and he is restrained.
2)MI- second day. Oriented x 3, free from painNURSE B3)TURP on CBI with light red outflow, oriented x3
4)cerebral bleed, unresponsive. Currently on ventilator for 4 weeks with no change in status.NURSE C5)COPD exacerbation
6) Brain stem infarct. Recovering. Oriented X 3. Has slurred speech and dysphagia. In the hospital for 3 days.NURSE D7) New admission that is being worked up for R/O MI. No chest pain currently.
8) Jaundice , pruritus and elevated liver enzymes. Patient on Demerol and Vistaril IM for severe colicky abdominal pain. I'm struggling to finish my homework. I appreciate your help.
Answers:
B - Bleeding usually has to be stopped first.
the cerebral bleed should come first if the bleeding is new.
next I would take the jaundice patient.
when I was on the air force, we triaged pts simple first, life-threatening last. in the real world, always start on the non-stable and work back to stable or no change.
#5 the COPD patient. Here is my reasoning:#1- has sitter and is in 4 points;
#2- status post MI - stable
#3- sounds like normal post-op drainage.
#4- Gorked - no change, not gonna change
#6- stable
#7- waiting for blood results
#8- pain management in progress. Might need a stronger med order - but sounds stable to me.

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