Prioritizing - Exam 2 Flashcards Preview

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Flashcards in Prioritizing - Exam 2 Deck (23):
1

Priority Setting Framework

  1. ABCs
  2. Maslow's hierarchy of human needs
  3. The Nursing Process

2

ABCs

Since airway, breathing, and circulation are absolutes for sustaining life, they must be assessed and supported before other issues are tackled

3

Maslow's Hierarchy

Maslow's pyramid is the basis for all nursing care. The concept that the lower portions of the pyramid must be supported before the higher level needs are met is a basis for meeting the basic needs of the patient.

4

What do you do when the priorities of the nurse and patient differ?

The goal is to integrate and include the preference of the patient in setting priorities as much as possible using explanations and negotiation. Maslow's hierarchy can be a very valuable tool to assist in meeting the goals of both the patient and nurse. The preference of the patient should be a high priority., as long as it does not cause harm. For example, the paitent who returns from a hemodialysis procedure, exhausted from the treatment, and refusing to ambulate because rest is a priority at that time, should be allowed to do so to regain strength needed for the activity. However, you cannot negate a high priority like pohysiologic assessment for bleeding at the hemodialysis access site after the treatment for uninterrupted rest. A pre-procedure explanation can contribute to a tone of acceptance.

5

How do you prioritize care for a group of patients?

  1. Use a flow sheet to document and coordinate care for your assigned patients
  2. Round on your patients immediately after shift report. Go to the sickest patient first to ensure safety (physical, emotional, and environmental)
  3. Determine who is capable of self-care and initiate that process. This is also a good time to evaluate your patient's comfort to detemine need for prn medications. Check IV access patency and equipment supplies so the supplies can be gathered and be brought to the room together
  4. Determine which supplies you can take to the patient's room at the same time. You may perform patient teaching and assessment, discussing the plan of care for the shift with the patient or administer prn medications

6

Stable VS Unstable

Used when two patients have needs in the same area.

Has the issue affected the patient's vital signs or basic function?

7

Expected VS Unexpected

Used when two patients have needs in the same area.

Are the symptoms the RN is seeing expected in the disease process or the procedure? If not, they may indicate a larger problem. This could also be called known VS unknown

 

8

Actual VS Potential

Used when two patients have needs in the same area.

Is the problem actually happening right at the moment or is there the possibility of it happening? The actual issue would take precedence

9

Acute VS Chronic

Used when two patients have needs in the same area.

Are the signs and symptoms demonstrated by the patient due to a chronic condition or are they new and acute?

10

Age Extremes VS Risk/Benefit

Used when two patients have needs in the same area.

Does the patient's age move them higher on the priority list compared to the benefit for other patients? Do extremely old or young patients have a higher risk of serious issues than the rest of the assignment?

11

Prioritizing care for an individual patient

The nurse should gather background information first. The rule of ABCs still follows with an individual but once the patient safety issue is assessed, how does the nurse set up care for the day? Does the patient have an acute need? Does the patient have multiple needs at once requiring a long period of time? Does the patient have a test scheduled that might change the normal routine? Does the patient require uninterrupted rest periods? Does the patient have medication that requires pre or post assessment or exact timing?

12

Prioritizing Risk/Benefit

When the RN determines the priority for one patient, there is a benefit to that patient but it incurs possible risks to other patients on that RN's assignment. For example, the RN is called in to see a patient who is having chest pain. WHile the RN is there the other 3 patients on the RN's assignement are not be assessed. Some accommodations may need to be made to make sure there is no added risk for thos epatients. This also applies to bed assigning for patients. Which patients can be placed with another without increased risk? In these days of economic stress the main factor in this choice is the risk of infection. Does the patient in the room have a compromised immune system that would put othe rpotential roommates at risk?

13

Assessment

A complete assessment is used to gether objective and subjective data. However, a complete assessment is sometimes unnecessary or impossible due to competing priorities for the nurse's time. A focused assessment can sometimes be used to replace a complete assessemnt. A focused assessment is based on the current chief complaint of the patient, and progress of the admitting complaint. This type of assessment is frequently used for patients familiar to the RN

14

Nursing Diagnosis

This aspect of the nursing process allows for identification and definition of the problem using assessment data. Nursing diagnoses is ranked High, Medium, or Low. Address highest priority nursing diagnosis first. Keep in mind that it is sometimes necessary to deal with more than one priority diagnoses at the same time

15

Planning

Develop your plan of care in order of priority. Decide and document which task should be completed first and why. Remember that your plan may change several times based on the medical status changing needs of patient, staff and healthcare facility

16

Implementation

Order tasks to be performed based on priority needs of the patient. Many priority interventions may be carried out simultaneously. Consider that interventions how they are dequenced may changed affecting the plan of care.

17

Evaluation

Plan of care is continuousuly revised based on its effectiveness and/or resolution of patient problems

18

Time sensitive medications

These include all medications that must be given before meals or before or right after blood draws such as insulins, medications requiring peaks/troughs, or those that follow circadean rhythms

19

Medications for acute changes

If the patient is exhibiting assessment data indicating an acute change in condition and there are medications ordered for this change, the medication takes priority. For example, insulin may be high priority when the patient's BG exceeds 500, medication to lower BP during hypertensive crisis, or pain medication for severe pain. Many times these medications are given IV or IV push for rapid onset.

20

Prior assessment data

Administration of some medications is dependent on prior assessment data. Sometimes that data can change the dose or eliminate the dose completely. Some examples are BGs and sliding scale insulin or BP or pulse parameters for antihypertensives or cardiac medications.

21

Multiple Doses

Medications with multiple doses, espeically frequent doses require that the doses be spaced apart at regular intervals. This may move up their priority administration over a medication given once a day.

22

Verbal Orders

May be accepted in emergency situations or when a practitioner is unable toa ccess computerized information

  1. Write down the complete order in the chart order sheets
  2. Then read it back
  3. Recieve confirmation from the individual who gave the order
  4. In highly emergent cases where writing the information down for read-back would be impractical or impede patient care, the person accepting the order should repeat it back to the individual giving the order and receive confirmation that it is correct. When time permits the order should be documented in the paitent's medical record of entered into CIS.

23

Verbal Reports of Critical Test Results

  1. The reciever of the critical test result should write down the result as conveyed, then read it back and receive confirmation from the individual who conveyed the results
  2. The person accepting a verbally transmitted ciritcal test result must also ensure that the patient's care provider(s) are aware of the results

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