Slide 2 Slide 3 PRIORITIZATION OF NURSING CARE Dr. Sheryl
Cornelius, EdD, MSN, RN Slide 4 Objectives: Define prioritization
and the concepts surrounding prioritization of patient care Compare
and contrast ways to base the prioritization of patient care
Utilize principles of prioritization to determine which patient
needs to be seen first Slide 5 What is prioritization? Definition
Prioritization is the organization of activities according to the
order in which they should be done. ( Marquis, B. L. & Huston,
C. J., 2009) Slide 6 Ways to base the prioritization Emergency
first: ABCD Respond to trends vs. isolated findings Actual before
potential Systemic before local Acute before chronic Maslows
Hierarchy Time Management Infection control issues Slide 7
Emergency First: A B C D A: AIRWAY Assess for patent airway
Establish airway, if indicated 3-5 minute window for oxygenation B:
BREATHING Assess breathing and its effectiveness Intervene as
appropriate C: CIRCULATION Identify circulation concern Act as
appropriate to reverse circulatory problem. D: DISABILITY Assess
for disability Act to slow down development of disability Slide 8
Trends vs. Isolated Findings Vital signs Pain scale Level of
consciousness Glasgow Coma Scale Slide 9 Actual Problem vs.
Potential Problem Slide 10 System vs. Local Life over Limb Slide 11
Acute Problem vs. Chronic Problem Slide 12 Maslows Hierarchy Slide
13 Time Management Immediately Within a specific time frame By the
end of the shi f t Least amount of time to complete Slide 14
Infection Control Issues See the most infectious patient last
whenever possible. Slide 15 Conclusion Read the entire question and
highlight key words to decide which method to use to prioritize
your care Slide 16 A nurse receives the following change of shift
report: 35 year old admitted yesterday after surgery for a ruptured
appendix Diagnosis: Peritonitis secondary to a ruptured appendix
Vital signs: T 101 F, P 108/min, R 26/min, BP 148/78 mm Hg, O2 1
L/min per NC, Pulse oximetry readings have decreased from 98% to
89% over the last 4 hr, NPO except for ice chips, Jackson Pratt
drain: brown purulent fluid moderate amount, D51/2NS at 100mL/hr
IV, Morphine PCA, AM Lab results: Hgb 2.0 g/dL(preop 12.8g/dL); Hct
37% (preop 39%), Platelets 165,000/mm3 (preop 150,000/mm3), WBC
23,500/mm3 (preop 18,700/mm3) Based on the information provided in
the change of shift report, the nurse should assign initial
priority to which reported client finding? A) Jackson Pratt
drainage B) Heart rate C) Temperature D) Oxygen saturation level
Question 1 LaCharity, Kumagai,& Bartz (2011) Slide 17 A nurse
receives the following change of shift report: 35 year old admitted
yesterday after surgery for a ruptured appendix Diagnosis:
Peritonitis secondary to a ruptured appendix Vital signs: T 101 F,
P 108/min, R 26/min, BP 148/78 mm Hg, O2 1 L/min per NC, Pulse
oximetry readings have decreased from 98% to 89% over the last 4
hr, NPO except for ice chips, Jackson Pratt drain: brown purulent
fluid moderate amount, D51/2NS at 100mL/hr IV, Morphine PCA, AM Lab
results: Hgb 2.0 g/dL(preop 12.8g/dL); Hct 37% (preop 39%),
Platelets 165,000/mm3 (preop 150,000/mm3), WBC 23,500/mm3 (preop
18,700/mm3) Based on the information provided in the change of
shift report, the nurse should assign initial priority to which
reported client finding? A) Jackson Pratt drainage B) Heart rate C)
Temperature D) Oxygen saturation level Answer 1 Slide 18 A nurse
receives a change of shift report at 0700 for an assigned caseload
of clients. Choose the order in which the clients should be seen.
1) A client who has been receiving a blood transfusion since 0400
2) A client who has an every 4 hour PRN analgesic prescription and
who last received pain med at 0430 3) A client who is going for
colonoscopy at 1130 and whose informed consent needs to be verified
4) A client who needs rapid onset insulin before the 0800 trays
arrive 5) A client who is being discharged today and needs
reinforcement of teaching regarding dressing changes A) 3,1,5,2,4
B) 4,2,3,5,1 C) 1,4,2,3,5 D) 2,3,1,4,5 Question 2 LaCharity,
Kumagai,& Bartz (2011) Slide 19 A nurse receives a change of
shift report at 0700 for an assigned caseload of clients. Choose
the order in which the clients should be seen. 1) A client who has
been receiving nitroglycerin for intermittent chest pain since 0600
2) A client who has an every 4 hour PRN analgesic prescription and
who last received pain med at 0430 3) A client who is going for
colonoscopy at 1130 and whose informed consent needs to be verified
4) A client who needs rapid onset insulin before the 0800 trays
arrive 5) A client who is being discharged today and needs
reinforcement of teaching regarding dressing changes A) 3,1,5,2,4
B) 4,2,3,5,1 C) 1,4,2,3,5 D) 2,3,1,4,5 Answer 2 Slide 20 A nurse is
preparing to insert a second intravenous catheter (IV) in a client
who needs to receive packed red blood cells (PRBC) in addition to
his IV antibiotics. Using time management principles, in which
order should the nurse perform the following steps? 1) Mentally
envision the procedure when collecting supplies for the
venipuncture. 2) Enter the room and perform hand hygeine. 3) Gain
informed consent from the client for infusion of PRBC's. 4) Prepare
the client and perform the venipuncture. 5) Follow protocol to
obtain blood from the lab. A) 2,1,3,4,5 B) 3,5,1,2,4 C) 1,2,4,5,3
D) 3,1,2,4,5 Question 3 LaCharity, Kumagai,& Bartz (2011) Slide
21 A nurse is preparing to insert a second intravenous catheter
(IV) in a client who needs to receive packed red blood cells (PRBC)
in addition to his IV antibiotics. Using time management
principles, in which order should the nurse perform the following
steps? 1) Mentally envision the procedure when collecting supplies
for the venipuncture. 2) Enter the room and perform hand hygeine.
3) Gain informed consent from the client for infusion of PRBC's. 4)
Prepare the client and perform the venipuncture. 5) Follow protocol
to obtain blood from the lab. A) 2,1,3,4,5 B) 3,5,1,2,4 C)
1,2,4,5,3 D) 3,1,2,4,5 Answer 3 Slide 22 A few minutes after the
nurse has given an intradermal injection to a patient who is
undergoing skin testing for allergies, the patient complains about
feeling anxious, short of breath, and dizzy. Which of the actions
included in the emergency protocol should the nurse take first? A)
Start O2 at 4L/min NC B) Obtain IV access with a large bore
catheter C) Administer epinephrine (Adrenalin) 0.3 mL SQ D) Give
albuterol (Proventil) 2.5 mg via nebulizer Question 4 LaCharity,
Kumagai,& Bartz (2011) Slide 23 A few minutes after the nurse
has given an intradermal injection to a patient who is undergoing
skin testing for allergies, the patient complains about feeling
anxious, short of breath, and dizzy. Which of the actions included
in the emergency protocol should the nurse take first? A) Start O2
at 4L/min NC B) Obtain IV access with a large bore catheter C)
Administer epinephrine (Adrenalin) 0.3 mL SQ D) Give albuterol
(Proventil) 2.5 mg via nebulizer Answer 4 Slide 24 After the nurse
receives the change-of-shift report, which client should be
assessed first? A) An 18 month old with coarctation of the aorta
who has decreased pedal pulses B) A 3 year old with rheumatic fever
who is complaining of severe knee pain C) A 5 year old with
endocarditis who has crackles audible throughout both lungs D) A 8
year old with Kawasaki disease who has a temp of 102.2 Question 5
LaCharity, Kumagai,& Bartz (2011) Slide 25 After the nurse
receives the change-of-shift report, which client should be
assessed first? A) An 18 month old with coarctation of the aorta
who has decreased pedal pulses B) A 3 year old with rheumatic fever
who is complaining of severe knee pain C) A 5 year old with
endocarditis who has crackles audible throughout both lungs D) A 8
year old with Kawasaki disease who has a temp of 102.2 Answer 5
Slide 26 After the nurse receives the change-of-shift report at
7:00 AM, which client should be assessed first? A) A 23 year old
with a migraine headache who is complaining of severe nausea
associated with retching B) A 45 year old who is scheduled for a
craniotomy in 30 minutes that needs pre op teaching C) A 59 year
old with Parkinsons disease who will need a swallowing assessment
before breakfast D) A 63 year old with MS who has an oral temp of
101.8F and flank pain Question 6 LaCharity, Kumagai,& Bartz
(2011) Slide 27 After the nurse receives the change-of-shift report
at 7:00 AM, which client should be assessed first? A) A 23 year old
with a migraine headache who is complaining of severe nausea
associated with retching B) A 45 year old who is scheduled for a
craniotomy in 30 minutes that needs pre op teaching C) A 59 year
old with Parkinsons disease who will need a swallowing assessment
before breakfast D) A 63 year old with MS who has an oral temp of
101.8F and flank pain Answer 6 Slide 28 The nurse observes a UAP
performing all of these interventions for a patient with carpel
tunnel syndrome. Which action requires the nurse intervene
immediately? A) Arranging the patients lunch tray and cutting his
meat. B) Providing warm water and assisting the patient with his
bath C) Replacing the patients splint in hyperextension position D)
Reminding the patient not to lift heavy objects Question 7
LaCharity, Kumagai,& Bartz (2011) Slide 29 The nurse observes a
UAP performing all of these interventions for a patient with carpel
tunnel syndrome. Which action requires the nurse intervene
immediately? A) Arranging the patients lunch tray and cutting his
meat. B) Providing warm water and assisting the patient with his
bath C) Replacing the patients splint in hyperextension position D)
Reminding the patient not to lift heavy objects Answer 7 Slide 30 A
patient hospitalized with ulcerative colitis reports 10 to 20 small
diarrhea stools per day, with abdominal pain before defecation. The
client appears depressed and underweight and is uninterested in
self-care or suggested therapies. What is the priority nursing
diagnosis? A) Diarrhea related to irritated bowel B) Imbalanced
nutrition: less than body requirements related to nutrient loss C)
Acute pain related to increased GI motility D) Ineffective
therapeutic regimen related to treatment plan Question 8 LaCharity,
Kumagai,& Bartz (2011) Slide 31 A patient hospitalized with
ulcerative colitis reports 10 to 20 small diarrhea stools per day,
with abdominal pain before defecation. The client appears depressed
and underweight and is uninterested in self-care or suggested
therapies. What is the priority nursing diagnosis? A) Diarrhea
related to irritated bowel B) Imbalanced nutrition: less than body
requirements related to nutrient loss C) Acute pain related to
increased GI motility D) Ineffective therapeutic regimen related to
treatment plan Answer 8 Slide 32 Case Study Concept: Managing Care
Exemplar: Prioritization Course: NUR 212 Prioritization: You are
the registered nurse (RN) and you will have a group of six clients
on a medical surgical unit in an acute care setting. Based on the
following clients, answer the questions below. Slide 33 The clients
are as follows: Room 101: A 19 year old female with asthmatic
bronchitis and general anxiety disorder that has been crying all
night and is asking that no visitors are allowed. She is concerned
about missing her college classes due to the hospitalization and
fears she may fail the semester. Each time her anxiety increases
her breathing worsens and she suffers an asthma attack with
bronchospasms. Room 102: A 92 year old male with dementia and
pneumonia. He has a bed alarm and has a history of falls. He will
not use the call bell when getting up to the bathroom. Room 103: An
obese 57 year old male admitted after a motor vehicle accident last
night while driving impaired. He has a chest tube for atelectasis.
He has cardiac contusions and is on a telemetry monitor in normal
sinus rhythm. He has been sleeping soundly since the chest tube was
put in on admission 10 hours ago. Room 104: A 54 year old female
with uterine cancer. She is three days status post abdominal
hysterectomy with subsequent dehiscence of wound 12 hours post op.
The wound is being packed with normal saline soaked Nugauze three
times a day. She is receiving chemotherapy and is neutropenic on
reverse isolation. Room 105: A 67 year old male with Clostridium
Difficile and Vancomycin Resistant Enterococcus (VRE). He has been
complaining of abdominal cramps and diarrhea all night. The stools
have subsided and he has just gone to sleep. Room 106: A newly
admitted 55 year old female with anemia and possible
gastrointestinal (GI) bleed that has not been assessed. She does
not have an IV access. She will be receiving 2 units packed red
blood cells (PRBC) ASAP. Slide 34 1)Which patient should be seen
first? Second? Provide rationale. 2) Which patient should be seen
last? Provide rationale. 3) You have assessed everyone and are
preparing to give AM meds and treatments. Order the treatments and
meds in the order that benefit the patients. Provide rationale. A)
Xanax for Room 101who has increased respirations and is coughing
after receiving a call from her classmate. B) A BID dressing change
to abdomen in Room 104 C) Daily meds for Room 102 who has increased
blood pressure that he has not had prior. D) Hang second unit of
blood in Room 106 E) A call from Room 103 that he stepped on his
chest tube on way to bathroom and pulled it out and is having
problems breathing. Questions Slide 35 References LaCharity, L.,
Kumagai, C. & Bartz, B., (2011). Prioritization, Delegation,
and Assignment. Port Ludlow, Washington: Mosby, Elsevier. Marquis,
B. L. & Huston, C. J. (2009). Leadership roles and management
functions in nursing: Theory and application. (6 th ed.).
Philadelphia : Lippincott, Williams & Wilkins. Taylor, C.,
Lillis, C., Lemone, P., (2011). Fundamentals of Nursing: The Art
& Science of Nursing Care. (7 th ed.) Philadelphia, Lippincott,
Williams & Wilkins.
