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Difficulty: MediumEmergency Response Plan

A local hospital has activated its emergency operations plan due to a nearby bridge collapse resulting in mass casualties. The nursing supervisor instructs the medical-surgical unit charge nurse to immediately identify clients for safe discharge to create surge capacity. Which of the following clients should the charge nurse recommend for immediate discharge?

  1. A client with lower extremity cellulitis who has received 48 hours of intravenous antibiotics and is prescribed to transition to oral antibiotics today.Answer
  2. B
    An 82-year-old client being treated for a urinary tract infection who became acutely restless and confused earlier this morning.
  3. C
    A client admitted 12 hours ago with atypical chest pain whose first set of cardiac enzymes was negative and is awaiting a scheduled echocardiogram.
  4. D
    A client 24 hours post-laparoscopic appendectomy who reports increased thirst, has a heart rate of 112 bpm, and a blood pressure of 102/60 mm Hg.

Answer

The client transitioning to oral antibiotics for cellulitis should be recommended for immediate discharge.
In a mass casualty situation where an emergency operations plan is activated, the charge nurse must identify clients who are physiologically stable and require the least amount of skilled nursing care. The client with cellulitis who is ready to transition to oral medications is hemodynamically stable, requires no further acute interventions, and can safely manage their condition at home, making them the appropriate choice to clear a bed for incoming victims.

Step-by-Step Solution

1
Analyze the goal of the emergency response plan.
The goal is to safely create surge capacity (free up beds) for incoming mass casualty victims by identifying the most stable clients.
Disaster protocols require prioritizing resources for the most critically injured while ensuring current inpatients are not discharged to an unsafe situation.
2
Evaluate the stability and discharge readiness of each client.
The client with cellulitis is stable and transitioning to home care. The older adult has acute confusion. The chest pain client is undiagnosed. The postoperative client shows early signs of shock.
Accurate clinical assessment determines which client requires ongoing acute care nursing intervention.
3
Select the client with the lowest acuity and risk of decompensation.
The client transitioning to oral antibiotics is chosen.
This client requires no further acute intravenous therapy or continuous monitoring and can safely recover in the community.

Key Concept

Discharge Prioritization during Mass Casualties
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Topics

Emergency Response Plan

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