Prioritization Flashcards
What are hypovolemia and hemorrhage?
C
What can O2 sat be?
A & B
What is at the bottom of Maslow’s hierarchy of needs?
physiological needs (food, elimination, safety, fluid, sex, comfort)
does ABC always trump maslows?
no. for example you can have a patient with a HR of 110 and an albumin level of 1.0 (3.4 to 5.4). you have both maslows and abc, Maslows trumps ABC because maslows is the underlying issue. because this patient is malnourished any cardiac meds you try to give to this patient are never going to work because there is no protein for the meds to bind to.
Which patient do you always choose first?
the most unstable patient (typically the patient that just come to the floor. whether it be from a procedure, operation, or the patient that has an ABC issue going on)
Who is your most stable patient?
patient who is about to be discharged or just needs teaching. teaching falls last!
which patients do you see first as far as time and scheduling go?
The patient that needs to go to the OR or go to a procedure are patients that you are going to see first over other patients. also, patients who have a wider time frame are secondary. For example, if you have something that is Q8 vs something that is Q2 you are going to see the patient with the Q2 first.
Delegation
If there is a task that you can delegate it goes at the bottom of your list
Agency Policies and procedures
for example, ADL checks every 2 hours and safety checks are a priority when they are imminently due.
Patient and family preferences
the patient/family who is screaming the loudest and ringing the call bell the most IS NOT your priority (unless they are in physical or psychological distress) do not let patients like this distract you from more serious situations. those patients can wait or you can get the charge nurse to go talk to that patient/family while you are dealing with something more serious such as a patient having a seizure or going into CHF.
care activities related to condition of patient
- first is life threatening or potentially life threatening occurrences such as BIG changes in VS, LOC, and lab values.
- patient safety does come second to the things listed above. you can delegate a nursing assistant to go check on the patient who is a safety concern (such as someone who may fall/infection)
Medication or IV therapy priorities
need to decide which meds to give first to patient. meds that prevent physiological distress are meds that take priority over something like a multi vitamin
Patients with lines and tubes
check patients with ingoing lines first (central lines, then peripheral lines) then check patients with outgoing lines second ( GT/NGT and foley/colostomy)
short term needs vs long term needs
address actual/short term needs prior to risk for/potential and long term needs (could have patient with something like myasthenia gravis but also has pneumonia, well the myasthenia gravis is a chronic condition that the patient has had for a while and pneumonia is an acute condition. you want to treat the pneumonia first)
General patient problems that usually indicate priority status (PRESSVC)
- fresh post operative patient (newly arrived from PACU. Can’t delegate this to CNA because a fresh post op patient is not considered stable. CNAs CAN’T TOUCH unstable patients)
- Patients whose status has declined from baseline (this is why you have to look at trends in the patients VS, lab values, etc so you can recognize when the patient is going downhill)
- patients with any kind of shock or allergic reactions (RULE OF THUMB, if you are a nurse out in the community setting you ACT FIRST instead of assessing. for example, if you are a nurse out in the community environment and someone is having an asthma attack you give them there inhaler or if someone comes to an allergy clinic with an anaphylaxis reaction you give them their epi pen. In this situation you ARE NOT GOING TO ASSESS FIRST. YOU ACT FIRST)
- patients with chest pain (not your job to determine where it is coming from that is MD job. once you hear chest pain kick it up to the top of the list)
- patients that have returned from a diagnostic procedures (require temporary more intensive monitoring and CNA can’t touch this patient until RN determines that patient to be stable)
- patients that verbalize unexpected or unusual symptoms (for example, someone with a snake bite who is suddenly SOB vs someone with a hip fracture who is having pain. well pain is an expected finding but SOB from a snake bite is not)
- patients that have equipment or tubing malfunction (cardiac/ventilator alarms. MUST LISTEN TO THESE ALARMS)
