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Difficulty: Very hardEstablishing Priorities

An oncology nurse is reviewing the most recent clinical updates for 44 assigned clients. Based on the principles of prioritization, which client requires the nurse's immediate assessment?

  1. A
    A client with acute myelogenous leukemia (AML) who has a temperature of 102.4∘102.4^\circ F (39.1∘39.1^\circ C), a blood pressure of 88/5488/54 mm Hg, and an absolute neutrophil count of 150/mm3150/\text{mm}^3
  2. A client with small cell lung cancer who has progressive facial edema and reports a new onset of dysphagia and throat tightnessAnswer
  3. C
    A client with multiple myeloma who has a serum calcium level of 14.814.8 mg/dL (3.73.7 mmol/L) and is exhibiting profound lethargy and a heart rate of 4848 beats/min
  4. D
    A client with tumor lysis syndrome who has a serum potassium level of 6.46.4 mEq/L (6.46.4 mmol/L) and is reporting new-onset perioral paresthesia

Answer

The client with small cell lung cancer reporting a new onset of dysphagia and throat tightness requires immediate assessment.
The correct answer is the client with small cell lung cancer reporting dysphagia and throat tightness. These symptoms, combined with facial edema, are classic signs of Superior Vena Cava (SVC) syndrome complicated by laryngeal or tracheal compression. In the Airway-Breathing-Circulation (ABC) prioritization framework, an impending airway obstruction represents the most immediate threat to life and requires instantaneous intervention to secure the airway before complete respiratory arrest occurs.

Step-by-Step Solution

1
Analyze the clinical presentation of each client to identify the underlying pathophysiological emergency.
Identified four oncologic emergencies: neutropenic sepsis, superior vena cava (SVC) syndrome with airway compression, hypercalcemic crisis, and tumor lysis syndrome with hyperkalemia.
Accurate identification of the underlying crisis is required before prioritizing care.
2
Categorize each emergency using the Airway-Breathing-Circulation (ABC) prioritization framework.
SVC syndrome with dysphagia (Airway), neutropenic sepsis (Circulation), hyperkalemia (Circulation/Cardiac), and hypercalcemia (Neurological/Cardiac).
The ABC framework provides a standardized, evidence-based method for determining survival priority.
3
Rank the clients based on the highest level of physiological threat.
The client with SVC syndrome and throat tightness is ranked first because airway obstruction causes death more rapidly than distributive shock, dysrhythmias, or metabolic crises.
Without a patent airway, all other interventions (such as fluid resuscitation or electrolyte correction) are futile.

Key Concept

Applying the Airway-Breathing-Circulation (ABC) framework to prioritize among multiple life-threatening oncologic emergencies.
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Establishing Priorities

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