Lecture Notes: Patient Prioritization

Introduction

• Speaker: Meris
• Topic: Patient prioritization in nursing
• Tools: Leadership flashcards from Fundamentals of Nursing deck

Key Models of Patient Prioritization

1. Nursing Process (ADPIE)

• Assessment: Gather data, evaluate patient condition (e.g., vital signs, breath sounds).
• Diagnosis: Analyze data to identify actual or potential health problems.
• Planning: Set measurable and achievable goals; discharge planning.
• Implementation: Carry out the care plan (e.g., medication administration, patient positioning).
• Evaluation: Assess the effectiveness of interventions and adjust care plans accordingly.

2. Maslow’s Hierarchy of Needs

• Physiological Needs: Must be met first (e.g., food, water, shelter).
• Safety and Security: Next layer (e.g., physical safety, stability).
• Psychological Needs: Higher layers include love, belonging, and self-actualization.
• Application: Prioritize physiological needs in patients, e.g., address malnutrition before psychological concerns in anorexia nervosa.

3. ABC Setting Priority

• Airway, Breathing, Circulation: Prioritize in this order in most cases.
• Exceptions: CPR guidelines may alter order.
• Examples: Prioritize breathing issues like wheezing over chest pain due to oxygenation concerns.

Setting Priorities in Patient Care

Acute vs. Chronic

• Acute Conditions: Take priority due to immediate threat.
• Example: Asthma attack (acute) vs. COPD baseline difficulty (chronic).

Unexpected vs. Expected Findings

• Unexpected Findings: Require immediate attention.
• Example: Unilateral leg swelling in CHF is less expected than mild edema.

Procedures and Interventions

Least Restrictive/Invasive First

• Start small: Use simple measures before complex (e.g., turning on faucet before Foley catheter).
• Restraining Techniques: Use verbal de-escalation before physical restraints.

Survivability Potential (Mass Casualty)

• Sickest survive: Prioritize patients likely to survive with treatment.
• Example: Sucking chest wound over penetrating head wound.

Review Questions

1. Maslow’s Hierarchy: Prioritize imbalanced nutrition over body image due to physiological need.
2. CHF Prioritization: New-onset leg pain and swelling are unexpected and prioritized over 1+ pitting edema.
3. Mass Casualty Triage: Prioritize sucking chest wound over penetrating head wound due to survivability.

Conclusion

• Encouraged to share insights and experiences relating to patient prioritization.
• Invitation to subscribe and engage with content for further learning.