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Difficulty: MediumAssignment, Delegation and Supervision

A registered nurse (RN) is planning care for a group of assigned clients on a medical-surgical unit. Arrange the clients in the order the RN should assess them, from first (highest priority) to last (lowest priority).

  1. 1A client with a newly casted fractured femur who reports sudden severe dyspnea and a feeling of impending doom.
  2. 2A client who is 12 hours postoperative and requesting intravenous analgesia for incisional pain rated 8 out of 10.
  3. 3A client with chronic obstructive pulmonary disease (COPD) who has a baseline oxygen saturation of 91% on room air.
  4. 4A client scheduled for discharge who requires evaluation of their ability to self-administer subcutaneous insulin.

Answer

The correct order of assessment is: 1) The client with a fractured femur and sudden dyspnea, 2) The postoperative client with severe incisional pain, 3) The client with COPD and a stable baseline oxygen saturation of 91%, and 4) The client preparing for discharge who requires insulin education.
The correct order follows the principles of prioritization in nursing: life-threatening ABC (Airway, Breathing, Circulation) emergencies first, followed by acute and urgent issues (severe pain), then chronic but stable conditions, and finally routine or administrative tasks (discharge teaching).

Step-by-Step Solution

1
Apply the ABCs (Airway, Breathing, Circulation) framework to identify any immediate life threats.
Identify the client with the fractured femur and sudden dyspnea as the highest priority.
Sudden severe dyspnea and impending doom indicate a potential fat embolism or pulmonary embolism, which is a critical airway and breathing emergency.
2
Evaluate the remaining clients using acute versus chronic and Maslow's Hierarchy of Needs frameworks.
Identify the postoperative client in severe pain as the second priority.
Acute, severe pain requires prompt intervention, but it does not pose an immediate threat to life compared to a respiratory emergency.
3
Compare the stability of the final two clients.
Identify the client with COPD as the third priority.
Although the oxygen saturation is 91%, this is an expected, stable baseline for a client with chronic COPD.
4
Assign the lowest priority to the most stable client.
Identify the client requiring discharge teaching as the final priority.
Education and evaluation are essential RN tasks but can be safely delayed until all acute physiological needs are addressed.

Key Concept

Prioritization of client care based on acuity, physiological stability, and the ABCs (Airway, Breathing, Circulation) framework.
Estimated Time:1m 30s
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Topics

Assignment, Delegation and Supervision

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