An oncology nurse is planning care for four assigned clients after receiving the morning handoff report. Based on the principles of prioritization, arrange the clients in the order the nurse should assess them, from first to last.
- 1A client who had a right subclavian central venous catheter placed 1 hour ago and now reports sudden shortness of breath
- 2A client with acute myelogenous leukemia (AML) and an absolute neutrophil count (ANC) of 400/mm³, who has a new-onset temperature of 101.2°F (38.4°C)
- 3A client with multiple myeloma who is reporting severe, new-onset lower back pain rated 9 on a 0-to-10 scale
- 4A client with terminal lung cancer who has persistent blood-tinged sputum and a resting oxygen saturation of 93% on room air
Answer
The correct order of prioritization is: first, the client with sudden shortness of breath after central line placement; second, the neutropenic client with a new fever; third, the client with severe lower back pain; and fourth, the client with expected chronic findings of terminal lung cancer.
The priority sequence follows the ABC framework and the principle of acute over chronic. The client with a new-onset breathing complication post-procedure (pneumothorax risk) is the most critical. Next is the neutropenic client with a fever, who is at high risk for fatal sepsis. The third priority is the client experiencing severe acute pain, which is distressing but not immediately life-threatening. Finally, the client with terminal lung cancer presents with chronic, expected findings and is the most stable.
Step-by-Step Solution
Key Concept
Establishing priorities involves addressing ABC (Airway, Breathing, Circulation) threats first, followed by highly unstable conditions (such as neutropenic sepsis risk), then urgent symptom management (such as acute pain), and finally chronic or expected findings.