Nursing Prioritization Delegation Assignment Q 77
After a change of shift, you are assigned to care for the following patients. Which patient should you assess first?
A. A 60-year old patient on a ventilator for whom a sterile sputum specimen must be sent to the lab.
B. A 55-year old with COPD and a pulse oximetry reading from the previous shift of 90% saturation.
C. A 70-year old with pneumonia who needs to be started on intravenous (IV) antibiotics.
D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.
Correct Answer: D. A 50-year old with asthma who complains of shortness of breath after using a bronchodilator.
The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications. This patient’s needs are urgent. In particular, a patient who is chronically on short-acting beta-2 agonists risks not achieving the same relief from their medicine as they once did. This phenomenon is called receptor downregulation. It happens because a portion of the receptors targeted end up being inactivated by the body due to overuse.
Option A: The sterile sputum specimen of the patient should be sent to the laboratory for not more than 60 minutes, or it will not be acceptable. This is not an urgent case and can be done after the nurse sees the other patients.
Option B: In COPD patients pulse oximetry oxygen saturations of more than 90% are acceptable. In the treatment of exacerbations of chronic obstructive pulmonary disease (COPD), oxygen should be titrated to achieve a target oxygen saturation range of 88–92%. This results in a greater than twofold reduction in mortality, compared with the routine administration of high-concentration oxygen therapy
Option C: The other patients need to be assessed as soon as possible, but none of their situations are urgent. Patients older than 60 years or younger than 4 years of age have a relatively poorer prognosis than young adults. If pneumonia is left untreated, the overall mortality may become 30%. The Pneumonia Severity Index (PSI) may be utilized as a tool to establish a patient’s risk of mortality.