Alright, so let's go into our prioritization with our patients. And I know that a lot of nursing school test questions talk about this because prioritizations and delegation is really big on the NCLEX and the national boards. So, um, prioritization is really not that difficult once you get it and neither is delegation so let's go over those real quick but let's do prioritization first so i mean i worked on the ambulance for a long time and i know that everyone's like abcs you know always just do abcs and you know that's priority that's you know Which patient's going to die first? Airway, breathing, circulation. Now, what if your test question, though, gives you a question in terms of, you know, three patients that are not even ABCs?
Then what do you do? You're like, crap. Right? So, I had to learn real quick that ABCs was not the whole, you know, prioritization with every single client.
Now, obviously, anyone who does have an airway breathing or circulation issue comes first in terms of priority. But what if you have, you know, three patients that... don't have those type of issues.
Well, we're going to talk about that right now. So in terms of Maslow's hierarchy of needs, pretty much your airway breathing circulation comes first. Next is your change in level of consciousness. So if your patient becomes altered, this is directly correlated to a safety issue. Okay?
So safety, that's huge for priority because if your patient is going to fall over and hurt themselves with this level of consciousness change, then that is a priority. Some other things in terms of prioritization. You have an infection or a type of sepsis that becomes a priority.
And you also have labs that directly correlate to your heart and lungs here. So, your patient who has sepsis is going to be of higher priority than your patient who has pain after a surgical procedure. Now, your patient with laboratory values, let's just say that their AVGs show respiratory acidosis. That is leading into criteria for acute respiratory distress syndrome.
Those labs directly relate to our airway breathing circulation. So that patient will go higher than someone suffering from an infection. Now let's say our ABGs, if you guys haven't seen my ABG lecture, or my... acute airway distress syndrome ARDS lecture, then check it out.
It's at the VIP video vault at simplenursing.com. But you have to know your ABGs. You have to know your criteria for your SIRS, your septic patients in terms of are they going into SIRS criteria? that systemic inflammatory reactive syndrome criteria.
So if you guys don't know that, then you're not going to be able to understand who goes first. In terms of your cardiac labs, your cardiac enzymes, does your patient have a high troponin? How is the CRP?
How is the CPK doing in terms of the vascular inflammation? Is this patient having an acute MI? How do you know?
Is their troponin higher than 0.04? So basically you kind of Create which patient is going to die first. That's how you prioritize your patients. Now in terms of diagnoses of which patient comes first, well, we're talking about, let's see, your diagnosis patients.
Usually the patients who come first are post-op patients. So if they're talking about... Who are you going to see first? And they give you like, let's say a patient three days in the hospital with COPD exacerbation, a patient with two days of a post-MI, or a patient that's fresh post-op from an angiocap.
Definitely take the post-op patient first, because there's so many things that can happen with a fresh post-op patient. We're talking the patient's barely coming out of, what's it called, being sedated. You're talking a patient who probably has a femoral... what's it called pressure device especially they got an angiocath and you're talking about a huge risk for bleeding a huge risk for your patient in terms of changing status so do not delegate that patient you have to take that patient for yourself and that would be in that case the first patient you assess. So we'll talk about pain in terms of where pain goes.
And pain in and of itself, where's my pen, goes in the second criteria here. Because pain... does not kill anyone.
Pain is manageable. And I know it sucks to leave your patient in pain, but it's not a priority. Really, pain is not going to kill you. It's uncomfortable, yes, but these things will kill your patient faster.
So, yeah. Let's see here. So, some other type of Some other type of diagnostics here would be, let's see, asthma exacerbation.
I didn't even spell that right. And neutropenic precautions. And your neutropenic patient would be a definitely huge safety risk for, in terms of who do you assess first?
Your post-op patients, your patients who are having an acute airway distress type of disorder, so like an asthma patient, goes back to ABCs, and your neutropenic patient who can have a risk for infection. So it really changes. It just depends on what is the priority at that time.
Really, which patient is in most danger at that time. Usually, nursing school tests are not going to trick you that much, but If you guys have any one of these type of patients, let's just say that the patient's been post-op for two days now. They're not fresh post-op.
And let's say this patient has been admitted to the hospital for an acute asthma attack for two days. This patient's been on neutropenic precautions for two days. Really all the same lineup, but is there any change in their condition?
that relates to their safety? Do I hear recent wheezing happening with my asthma patient? Do I have an increase in WBCs with my neutropenic patient?
Is there a change in LOC with my post-op patient, even if all these patients have been on the floor for two days and are considered stable? Really, is there a change? That's what we're looking for. And how does it relate back to your ABCs?