Prioritization

Question 1

Four rules of prioritization

Answer 1

1) acute beats chronic
2) freshly postoperative (first 12 hours) beats medical or other surgical
3) unstable beats stable
4) tie breaker: the more vital the organ the higher the priority (in reference to the organ of the modifying phrase, not the diagnosis)

Question 2

Words that count for stability

Answer 2

Stable, chronic illness, post-op over 12 hrs, local or regional anesthesia, lab abnormalities of an A or B level, phrases ready for discharge, to be discharged or admitted longer than 24 hrs, unchanged assessments (nothing new)

Question 3

Words that count for instability

Answer 3

Unstable, acute illness, less than 12 hrs post-op, general anesthesia in the first 12 hrs, lab abnormalities of a C or D, not ready for discharge, newly admitted, newly diagnosed or admitted less than 24 hrs ago, changing or changed assessment

Question 4

Patient is stable if they are experiencing _________ signs and symptoms of the disease with which they were diagnosed

Answer 4

Expected

Question 5

Patient is unstable is they are experiencing _________ signs and symptoms of the disease with which they were diagnosed

Answer 5

Unexpected

Question 6

4 things that are ALWAYS unstable

Answer 6

1) hemorrhage; NOTE: do NOT confuse with bleeding. Bleeding priority depends on whether it is expected or not
2) high fever over 105 (risk for seizures)
3) hypoglycemia
4) pulselessness or breathlessness (unless disaster triage)

Question 7

What are the three things that result in a black tag (disaster triage)?

Answer 7

Pulselessness, breathlessness, fixed and dilated pupils

Question 8

Organ vitality in order

Answer 8

Brain, lung, heart, liver, kidney, pancreas

Question 9

What CANNOT be delegated to LPN

Answer 9

• IVs: starting an IV, hanging/mixing IV meds, pushing IV meds; can ONLY maintain IV and document flow
• administration of blood
• central line/dressing care
• perform INITIAL assessment, provide teaching (can only REINFORCE teaching), or plan care (can only implement care)
• care for unstable patients
• admission, discharge, transfer

Question 10

What CANNOT be delegated to LPN

Answer 10

• IVs: starting an IV, hanging/mixing IV meds, pushing IV meds; can ONLY maintain IV and document flow
• administration of blood
• central line/dressing care
• perform INITIAL assessment, provide teaching (can only REINFORCE teaching), or plan care (can only implement care)
• care for unstable patients
• admission, discharge, transfer

Question 11

What CANNOT be delegated to the UAP?

Answer 11

• charting (can only chart what they did, not anything about the patient)
• administration of meds (can only apply topical OTC barrier creams)
• assessments (except for vitals and accuchecks)
• treatments (except for enemas)

Question 12

Interventions for managing inappropriate staff behavior

Answer 12

1) is what they are doing illegal? If yes, then always pick “tell supervisor.” If not, ask yourself #2.
2) is anyone in danger? If yes, confront immediately and take over. If illegal, do this first then tell supervisor. If not, ask yourself #3.
3) is this behavior legal and not harmful, but simply inappropriate? Approach them later and talk to them.

Question 13

Auscultation of heart valves

Answer 13

Aortic: 2nd right intercostal
Pulmonic: 2nd left intercostal
Erb’s Point: 3rd left intercostal
Tricuspid: 4th intercostal space left sternal border
Mitral (apical pulse): 5th intercostal space midclavicular line