Mark Klimek - Prioritization/Delegation Questions And Answers With Verified Study Solutions

Prioritization questions will always have: -Age -Gender -Diagnosis -Modifying Phrase What is important? - IGNORE age/gender Most important = modifying phrase Angina Pectoris vs Myocardial Infarction - who is higher priority? - MI Angina Pectoris with unstable BP vs Myocardial Infarction with stable vital signs - who is higher priority? - Angina pectoris with unstable BP (modifying phrase more important) *4 rules for prioritization* - 1. acute > chronic 2. fresh postop (first 12 hrs) > medical or other surgical 3. Unstable > stable 4. More vital the organ, the higher the priority (organ of the modifying phrase) (only use this as a tiebreaker) What is the tie-breaker used for prioritization questions? - More vital the organ, the higher the priority Vital Organs - order - BrainLung Heart Liver Kidney Pancreas Who is the priority? COPD CHF Appendicitis - Appendicitis (acute) Who is the priority? COPD CHF Appendicitis 2 hour post-op cholecystectomy 3 day post-CABG - 2 hour post-op cholecystectomy (fresh post-op within 12 hr) Who is the highest priority? A. 23 yr old male with CHF with a potassium of 6.6 and no ECG changes. B. Chronic Renal Failure with a creatinine of 20.7 and pink, frothy sputum.C. Acute hepatitis with jaundice and increased ammonia level, who you cannot arouse. - C. Acute hepatitis with jaundice and increased ammonia level, who you cannot arouse. Potassium = heart (3rd organ) Pink, frothy sputum is PE = Lung (2nd organ) Cannot arouse = brain (1st organ)*** UNSTABLE words - -Unstable -Acute illness -Post-op <12 hrs -General anesthesia (12 hrs) -Lab abnormalities of a C or D -Not ready for discharge -Newly admitted -Newly diagnosed -Admitted less than 24 hrs ago -Changed assessments -Unexpected signs/symptoms STABLE words - -Stable -Chronic illness -Post-op >12 hrs -Local/Regional anesthesia -Lab abnormalities of an A or B level -Ready for discharge -Admitted more than 24 hrs ago -Unchanged assessment -Experiencing the typical expected signs/symptoms with which they were diagnosedStable or Unstable: Kidney stones with severe colicky pain - STABLE because expected sign Stable or Unstable: Mild pain while having a chest x-ray - UNSTABLE because unexpected sign Who is the highest priority patient? 1. 16 yr-old female with meningitis who has had a temp of 103.8 since admission 3 days ago 2. 67 yr-old male with IBS who spiked a temp of 100.3 this afternoon - 2. 67 yr-old male with IBS who spiked a temp of 100.3 this afternoon BECAUSE...A patient with Meningitis is expected to have a fever. A patient with IBS who recently developed a fever is an unexpected and new symptom. Always high priority (5) - Hemorrhage Fever >105 (seizures) Hypoglycemia (<70) Pulseless Breathlessness Black tag (triage) - Pulselessness Breathlessness Fixed and dilated pupils LPNs can NOT: - -Starting an IV -Hang or mix IV meds -IV push meds -Administer blood -Central lines (no flushing, dressing changes, etc)-Care plans -Perform or develop teaching -Take care of unstable patients -Cannot do the 1st of anything (1st assessment, 1st post-op dressing, 1st feeding after stroke, etc) -Admission, discharge, transfer, first assessment after a change