You have been assigned 4 patients on an Intermediate Medical Care Unit. Two of the patients are post myocardial infarctions at various stages of their infarctions with multiple types of arrhythmias, the third patient is having drastic blood sugar fluctuations 218 down to 50 within minutes and its rebounds back up with changes in mentation and the fourth is reported to be having frequent TIA’s. One of the MI patients is having some dizziness and your TIA patient is presenting signs of impending stroke.
How would you prioritize your assessments and activities? How would you describe your critical thinking process and how do you organize and prioritize implementation of care?
Your initial response to the post should be 400 words in length and include proper APA formatting when referencing your resources.
RESPONSE POST/DISCUSSION POST ON PRIORITIZATION ON ASSESSMENT
In prioritizing implementation of care, firstly I would look at my assessment and plan of action. Firstly I would begin with the patient with the most unstable condition. Then if my plan of care determines that I delegate duties to other colleagues to help me in care of the critical patients. (Clark and Springer, 2012) After care of the TIA patient with impending stroke, my focus would be next take care of the patient with drastic blood sugar fluctuations then last the two post myocardial patients with arrhythmias. During this time I would avoid unnecessary tasks, note my responsibilities and give myself time.The patient with the higher risk of death will be definitely the earliest attended to and the patient who seems stable will be the last to be attended to (Fleming et al, 2019). In general, the priority regarding the assessment and future actions will be based entirely on how stable the patient is.
Lake, S., Moss, C., & Duke, J. (2009). Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision‐making literature. International Journal of Nursing Practice, 15(5), 376-388.
RN, E. S., & RN, M. C. (2002). Critical thinking in nursing education: Literature review. International journal of nursing practice, 8(2), 89-98.
Clark, C. M., & Springer, P. J. (2012). Nurse residents’ first-hand accounts on transition to practice. Nursing outlook, 60(4), e2-e8.
I would begin prioritizing my patients by assessing if the patients’ airway, breathing, and circulation are compromised at all. Then, I would move on to distinguish the urgent from the non-urgent and if there is an actual problem or potential problem. Starting with the ABCs, I start by noticing that all the patients have a patent airway and are breathing. The first patient I would see would be those with fluctuating blood glucose. This patient is unstable and is at risk for diabetic coma, which is life-threatening if not treated immediately. This is caused by blood sugar levels dropping too low or spiking too high (Heimgartner, Winkelman, & Ignatavicius, 2018). Diabetic coma can be caused by DKA, which could sometimes happen with blood sugar levels of 250 or lower. This is most common in people with type 1 diabetes (Heimgartner, Winkelman, & Ignatavicius, 2018). This patient would need frequent assessments and glucose checks. I would call the provider and alert them of the patient’s status.
My second priority patient would be the TIA, who presents signs of an impending stroke. The assessment I would do for this patient would be a focused neuro assessment. Depending on how this patient was doing, I would call a stroke alert and rapid response team. They will need a CT scan and thrombolytic medication if not already obtained. The third patient I would see would be the MI patient reporting dizziness. They may be experiencing dizziness from their medication, such as nitro. It could also be from dehydration and general weakness, but it could also be from decreased cardiac output. This patient would need frequent assessment, telemetry monitoring, EKG, and troponin levels checked which I would order and have done.
The last patient I would assess would be the post-MI patient who is not experiencing any additional symptoms besides arrhythmias which are normal after an MI. This would warrant me to not prioritize their needs as critical. They are rather stable and require EKGs, telemetry monitoring, and troponin levels checked.
Trying to assess and determine what patients need instant care first can be important in ensuring all lives and health status are optimized. Through the use of the ABCs: A for airway, B for breathing, and C for circulation as well as noticing obvious effects seen, I am able to understand who may a more urgent implementation of care.
Two of these patients were the most unstable, and I worked to cater to them first. Ultimately, I prioritized the patients I felt were the most dangerous in hopes of ensuring stable health qualities.
Heimgartner, N. M., Winkelman, C., & Ignatavicius, D. D. (2018). Medical Nursing: Concepts for Interprofessional Collaborative Care, 9th edition, Ignatavicius, Workman, Rebar: Clinical Companion (9th ed.). St. Louis, MO: Elsevier