Summary
Highlights
In a post-operative patient after aortic aneurysm repair, the most immediate concern is a high blood pressure (190/112). This is an unexpected and potentially dangerous finding compared to frequent PACs or lack of verbal response post-anesthesia, as high blood pressure affects circulation (ABC).
The speaker introduces two prioritization strategies for NCLEX questions. The first strategy is for questions where only the patient's diagnosis is known, and the goal is to identify unexpected findings. The second strategy applies when a patient's diagnosis and symptoms are provided, requiring prioritization of physiological, objective findings.
This strategy is used when only a patient's diagnosis is known. The key is to identify unexpected findings. The hierarchy for prioritizing issues is physiological (objective), then safety, then comfort (subjective), and finally, psychological issues.
A patient with chronic emphysema is presented, and the nurse needs to identify the most concerning finding. By evaluating each option as true/false for expected findings in emphysema, a respiratory rate of eight breaths per minute is identified as the unexpected and most concerning finding.
This strategy is applied when a patient has a diagnosis and symptoms. The nurse must prioritize objective physiological findings first. Subjective complaints (comfort issues) and psychological issues are addressed later.
A patient with Ebola virus exhibiting various symptoms is presented. The objective physiological finding is 750 ml of bloody emesis. The priority action is to infuse normal saline to address fluid loss, as it directly impacts this objective problem, before addressing subjective complaints like headache or nausea.
A patient with possible Avian Influenza, dyspnea, hypoxia, and dehydration requires prioritization. Hypoxia and dehydration are identified as objective physiological problems. Starting oxygen therapy is the first priority due to its impact on the crucial ABCs (Airway, Breathing, Circulation).
When faced with two physiological problems that aren't ABC-related, the nurse should prioritize the acute problem over the chronic one. For instance, diarrhea (acute) would be prioritized over malnutrition (chronic).
An 88-year-old patient with influenza-like symptoms requires prioritization of medications. Given the patient's strong likelihood of having the flu and the time-sensitive nature of Tamiflu (oseltamivir) for effectiveness, it is prioritized over symptomatic relief or the flu vaccine.
The video emphasizes that the 'right' answer depends on the context of other options. In the previous example, oseltamivir was prioritized because there were no other immediate life-threatening physiological problems. However, if a patient is hypoxic, addressing hypoxia takes precedence over administering oseltamivir, even if they have the flu.
A patient with chemotherapy-related neutropenia receiving filgrastim injections is presented. The most important finding to report is a white blood cell count of 39,000. While body aches are expected with filgrastim, and platelets at 110,000 are slightly low but not critical, a dramatically elevated white count (normal 5,000-10,000) is a highly unexpected and concerning finding.