Prioritization for PN/VN Student

Professor D introduces a Kahoot session on prioritization for PN/VN nursing students, welcoming RN students as well. She encourages viewers to like, subscribe, and visit her website for nursing resources like audio lessons and cheat sheets. She also promotes her social media presence under 'Nexus Nursing'.

The first scenario asks which of four clients should be seen first: a COPD patient, a pneumonia patient, a heart failure patient, or a fractured arm patient. The correct answer is the client with heart failure reporting new pink frothy sputum, which indicates pulmonary edema—a life-threatening emergency. The concept of 'new onset' as a priority indicator is highlighted. The professor warns against immediately calling a healthcare provider without first assessing the patient and gathering data, unless it is a case of suspected organ rupture.

The second scenario presents four clients and asks who to see first. The choices include a diabetic patient with high glucose, a dizzy patient, a chronic back pain patient, and a patient with new onset confusion and restlessness. The critical phrase 'new onset' again points to the priority patient: the one with new confusion and restlessness, which can signify hypoxia or infection, particularly in older adults. Subsequent priorities are discussed, including the dizzy patient (safety issue), the high glucose patient (not an immediate emergency compared to hypoglycemia), and the chronic pain patient (stable condition).

This scenario involves a UTI patient, a patient requesting antiemetic, a post-op patient with purulent drainage, and a chronic hypertension patient. The post-op patient with new purulent drainage is the priority due to potential infection, a key concern post-surgery, along with hemorrhage and DVT/pulmonary embolism. The high blood pressure is a secondary priority as it relates to physiological status. The UTI and nausea are addressed after more urgent issues. The professor emphasizes that signs of infection (purulent drainage, foul odor, increased temperature, warmth, elevated WBCs) and hemorrhage (decreased BP, increased HR/RR, decreased H&H/urine output, pallor, decreased O2 sat) are critical post-op concerns.

The fourth scenario asks to prioritize a client with an itchy cast, a client with a chest tube showing a significant increase in drainage, a patient requesting constipation medication, or a patient with a migraine. The priority is the chest tube patient whose drainage increased from 20ml to 200ml per hour, indicating possible active bleeding or thoracic injury. Other options are discussed, with the chest tube patient being a clear priority due to immediate physiological threat. The importance of the 'new' indicator and avoiding 'mild' symptoms as a priority is reinforced. Specific types of pain that are priorities, such as MI, sickle cell crisis, cancer, burns, and kidney stones, are also mentioned.

The final major scenario involves a patient with a history of seizures awaiting medication, a patient reporting new tingling and numbness below a cast, a stable chronic kidney disease patient requesting water, and a patient asking about discharge instructions. The priority is the patient with new tingling and numbness below a cast, as this suggests compartment syndrome, a medical emergency. The seizure patient is next, as timely medication prevents life-threatening events. The chronic kidney disease patient can be seen by a UAP for water, and discharge instructions are an RN's responsibility, not a PN/VN student's.

This scenario asks to prioritize clients on a med-surg unit. Options include a heart failure patient with difficulty breathing when lying flat, a COPD patient with 91% O2 sat on room air, a GERD patient requesting antacids, and a client awaiting a dressing change for a stable wound. The heart failure patient with orthopnea is the priority due to potential fluid overload or decompensated heart failure. A COPD patient with 91% O2 sat is typical for their condition and less urgent. Key differences between emphysema and bronchitis are highlighted, and the action of different GI medications (antacids, PPIs, H2 blockers) is emphasized for NCLEX. The stable wound is the last priority.

The last scenario asks which client requires immediate attention from four options: a patient with a cough and low-grade fever, a patient with sudden chest pain and shortness of breath, a fungal infection patient requesting cream, and a chronic anemia patient reporting fatigue. The patient with sudden chest pain and shortness of breath is the clear priority, as these symptoms can indicate a myocardial infarction or pulmonary embolism, requiring immediate assessment and intervention.