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Difficulty: MediumAssignment, Delegation and Supervision

At the beginning of the shift on a respiratory medical unit, the nurse receives a handoff report. In what order should the nurse assess the following clients? Arrange the clients from highest priority (first to assess) to lowest priority (last to assess).

  1. 1A client with an acute asthma exacerbation who is suddenly unable to speak in complete sentences and shows paradoxical breathing.
  2. 2A client who had a chest tube inserted yesterday and has drained 150 mL of bright red blood over the past hour.
  3. 3A client with community-acquired pneumonia who is scheduled to receive their first dose of intravenous antibiotics in 15 minutes.
  4. 4A client with chronic obstructive pulmonary disease (COPD) who requires discharge teaching regarding a new metered-dose inhaler.

Answer

The correct order is: the client with asthma unable to speak, followed by the client with the chest tube draining bright red blood, then the client needing scheduled IV antibiotics, and finally the client requiring discharge teaching.
Prioritization in nursing follows the ABC framework and the principle of treating unstable clients before stable clients. The asthmatic client has a critical airway/breathing emergency (first). The chest tube client has a circulatory emergency due to hemorrhage (second). The pneumonia client has a time-sensitive but stable need (third). The COPD client requiring teaching is stable and ready for discharge (fourth).

Step-by-Step Solution

1
Identify the client with an immediate threat to airway or breathing.
The client with asthma showing paradoxical breathing and inability to speak is experiencing impending respiratory failure.
Airway and breathing emergencies are the highest priority in any clinical scenario and must be addressed first to prevent death.
2
Identify the client with a circulatory emergency or high risk for hemodynamic instability.
The client with 150 mL of bright red chest tube drainage is experiencing active hemorrhage.
Circulatory issues are the next priority after airway and breathing (ABCs) are secured.
3
Identify the client requiring a time-sensitive, acute intervention.
The client needing their first dose of IV antibiotics in 15 minutes requires prompt, but not life-saving, attention.
Time-sensitive interventions for stable clients take precedence over routine or chronic care tasks.
4
Identify the most stable client requiring routine or discharge care.
The client requiring COPD discharge teaching is stable and ready to leave.
Education and discharge planning, while essential, can safely be delayed until all unstable or acutely ill clients are managed.

Key Concept

Prioritization frameworks: ABCs (Airway, Breathing, Circulation) and Stable vs. Unstable
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Topics

Assignment, Delegation and Supervision

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