Lecture Notes: Prioritization in Patient Care

Introduction

• Focus on prioritization and delegation in nursing, especially for NCLEX.
• Emphasis on foundational principles for prioritizing patient care.

Basic Principles of Prioritization

• Common method: ABCs (Airway, Breathing, Circulation)
  • Priority given to patients with airway, breathing, or circulation issues.
• Importance of recognizing non-ABC prioritization cases.

Maslow’s Hierarchy of Needs in Prioritization

• After ABCs:
  1. Change in Level of Consciousness
     • Directly related to patient safety (e.g., fall risk).
  2. Infection and Sepsis
     • Prioritize infections, especially if conditions are leading to sepsis.
  3. Lab Values
     • Particularly those relating to heart and lung function.
     • Example: Respiratory acidosis leading to ARDS.
     • Importance of understanding ABGs (Arterial Blood Gases).

Important Criteria and Considerations

• SIRS (Systemic Inflammatory Response Syndrome)
  • Recognize symptoms and criteria to prioritize appropriately.
• Cardiac Labs
  • Troponin, CRP, CPK levels.
  • Identify acute MI risk based on elevated troponin.

Prioritizing Post-Operative Patients

• Post-op patients often take priority, especially fresh post-op.
  • High risk due to sedation, bleeding risk, and changes in status.
  • Do not delegate fresh post-op patients.

Pain Management

• Pain is not a priority in life-threatening sense.
  • Manageable but not a direct threat to life.

Other Diagnostic Considerations

• Asthma Exacerbation
  • Relates back to ABCs.
• Neutropenic Precautions
  • High infection risk, requires priority assessment.

Assessing Changes in Patient Condition

• Evaluate for changes in stable patients (even if stable for 2 days).
  • Look for signs like recent wheezing, increased WBCs, or changes in LOC.
  • Relate changes back to ABCs for effective prioritization.

Conclusion

• Nursing tests usually do not overly complicate priorities.
• Always reassess for changes that impact ABCs and patient safety.