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Difficulty: MediumAssignment, Delegation and Supervision

After receiving the morning handoff report on a neurology step-down unit, the nurse must plan the initial client assessments. Arrange the following clients in the order they should be assessed, from first (highest priority) to last (lowest priority).

  1. 1A client with a recent subarachnoid hemorrhage who has become suddenly restless and complains of a worsening headache.
  2. 2A client with myasthenia gravis who is scheduled to receive their morning dose of pyridostigmine prior to breakfast.
  3. 3A client recovering from a transient ischemic attack who is waiting to be transported to a scheduled brain MRI.
  4. 4A client with Parkinson's disease who is stable and waiting for discharge teaching regarding a new levodopa prescription.

Answer

The correct priority order is: 1) The client with a subarachnoid hemorrhage and worsening headache, 2) The client needing time-critical pyridostigmine, 3) The client waiting for a scheduled MRI, and 4) The client awaiting discharge teaching.
Prioritization follows the framework of addressing acute, unstable, and life-threatening issues first, followed by time-sensitive interventions, scheduled activities, and finally routine or non-urgent tasks. The subarachnoid hemorrhage client is exhibiting acute instability. The myasthenia gravis client has a strict time-critical need. The TIA client is stable but has a scheduled commitment. The Parkinson's client requires a routine discharge intervention.

Step-by-Step Solution

1
Identify life-threatening or unstable conditions (ABCs and neurological emergencies).
The client with a subarachnoid hemorrhage exhibiting new restlessness and a worsening headache is experiencing an acute neurological decline.
Changes in level of consciousness and worsening pain after a hemorrhagic event indicate potential increased intracranial pressure or rebleeding, which requires immediate life-saving intervention.
2
Identify time-sensitive interventions that prevent deterioration.
The client with myasthenia gravis requires pyridostigmine prior to breakfast.
Without this medication, the client risks severe muscle weakness, which can rapidly compromise their airway and swallowing ability.
3
Evaluate remaining clients based on scheduled needs versus routine tasks.
The client scheduled for an MRI needs to be prepared before the client who is simply waiting for discharge.
Scheduled diagnostic procedures take precedence over routine discharge teaching, which can be completed at any point during the shift.

Key Concept

Prioritization of client care based on physiological instability, acuity, and time-sensitivity.
Estimated Time:1m 30s
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Topics

Assignment, Delegation and Supervision

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