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Question

Difficulty: MediumEstablishing Priorities

A pediatric emergency nurse is assigned to care for four newly admitted clients. Arrange the order in which the nurse should evaluate these clients, from highest priority (first) to lowest priority (last).

  1. 1A 4-year-old with a history of a peanut allergy who is actively coughing, drooling, and developing audible stridor.
  2. 2A 6-month-old infant with a ventricular septal defect exhibiting a resting heart rate of 190 beats/minute and diaphoresis.
  3. 3A 9-year-old with sickle cell anemia in a vaso-occlusive crisis reporting bilateral knee pain rated 8 on a 0-10 scale.
  4. 4A 7-year-old with a closed forearm fracture who has a capillary refill time of 2 seconds and normal sensation in the fingers.

Answer

First: The 4-year-old with drooling and stridor (Airway). Second: The 6-month-old with tachycardia and diaphoresis (Circulation). Third: The 9-year-old with severe sickle cell pain (Acute Pain). Last: The 7-year-old with a closed fracture and normal capillary refill (Stable/Localized).
Based on the ABC (Airway, Breathing, Circulation) prioritization framework, the nurse must first evaluate the client with impending airway obstruction (stridor, drooling). The second priority is the client with circulatory compromise (infant with heart failure signs). The third priority is addressing the severe acute pain of the client with a vaso-occlusive crisis. The final priority is the client with a localized, hemodynamically stable fracture.

Step-by-Step Solution

1
Identify any immediate threats to the airway or breathing.
The 4-year-old with drooling and stridor is experiencing an impending airway obstruction, a first-level priority.
Airway compromise leads to rapid respiratory failure and death. This client must be seen first.
2
Evaluate remaining clients for systemic circulatory threats.
The 6-month-old infant is exhibiting tachycardia (190 beats/minute) and diaphoresis, which are critical signs of decreased cardiac output and heart failure.
Circulatory collapse is the next most immediate threat to life after airway and breathing are secured.
3
Assess the remaining clients for acute distress or severe pain.
The 9-year-old is experiencing severe pain (8/10) from a vaso-occlusive crisis.
Acute pain is a high priority that requires prompt intervention, but it does not immediately threaten physiological survival in the same way as airway or circulatory collapse.
4
Identify clients with localized, stable, or expected findings.
The 7-year-old has a localized closed fracture with normal sensation and capillary refill (2 seconds).
Because neurovascular status is intact and the injury is localized, this client is physiologically stable and can safely wait while higher acuity clients are treated.

Key Concept

Prioritization using the ABC (Airway, Breathing, Circulation) framework and physiological stability
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Topics

Establishing Priorities

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