Mark Klimek
Lecture #12
February 3, 2018
Prioritizing
• You are deciding which patient is the sickest patient.
• Four parts usually in the answer
o Age
o Gender
o Diagnosis
o Modifying phrase
• Gender or age are irrelevant when it comes to prioritizing
• Modifying phrase is the most important
o If the patient had angina pectoris vs. MI = MI is priority
o If the patient had angina pectoris with unstable vital signs Vs. MI with stable
vital signs – angina pectoris is priority
Four rules of prioritization
1. Acute beats chronic
2. Fresh post-op (within 12 hours) beats medical or other surgical
3. Unstable beats stable
Stable Unstable
If it says they’re stable in the question Use of the word unstable
Chronic illness Acute illness
Post-op greater than 12 hours Post-op less than 12 hours
Local or regional anesthesia General anesthesia
Lab abnormalities of A or B level Lab abnormalities of C or D level
“Ready for discharge”, “to be discharged”, “Newly admitted”, “newly diagnosed”,
admitted admitted less
longer than 24 hours ago than 24 hours ago
Unchanged assessments Changed assessments, something new and
different
Experiencing the typical expected signs and Experiencing unexpected signs and symptoms
symptoms
of the disease with which they were diagnosed
4. The more vital the organ the higher the priority
a. Organ vitality
i. Brain
ii. Lung
iii. Heart
iv. Liver
v. Kidney
vi. Pancreas
Four things that make you unstable
1. Hemorrhage
2. High fevers over 105
3. Hypoglycemia
4. Pulseless or breathlessness
, Delegation
• Do you not delegate the following to an LPN
o Starting an IV
o Hanging or mixing IV meds
o IV push meds
Lecture #12
February 3, 2018
Prioritizing
• You are deciding which patient is the sickest patient.
• Four parts usually in the answer
o Age
o Gender
o Diagnosis
o Modifying phrase
• Gender or age are irrelevant when it comes to prioritizing
• Modifying phrase is the most important
o If the patient had angina pectoris vs. MI = MI is priority
o If the patient had angina pectoris with unstable vital signs Vs. MI with stable
vital signs – angina pectoris is priority
Four rules of prioritization
1. Acute beats chronic
2. Fresh post-op (within 12 hours) beats medical or other surgical
3. Unstable beats stable
Stable Unstable
If it says they’re stable in the question Use of the word unstable
Chronic illness Acute illness
Post-op greater than 12 hours Post-op less than 12 hours
Local or regional anesthesia General anesthesia
Lab abnormalities of A or B level Lab abnormalities of C or D level
“Ready for discharge”, “to be discharged”, “Newly admitted”, “newly diagnosed”,
admitted admitted less
longer than 24 hours ago than 24 hours ago
Unchanged assessments Changed assessments, something new and
different
Experiencing the typical expected signs and Experiencing unexpected signs and symptoms
symptoms
of the disease with which they were diagnosed
4. The more vital the organ the higher the priority
a. Organ vitality
i. Brain
ii. Lung
iii. Heart
iv. Liver
v. Kidney
vi. Pancreas
Four things that make you unstable
1. Hemorrhage
2. High fevers over 105
3. Hypoglycemia
4. Pulseless or breathlessness
, Delegation
• Do you not delegate the following to an LPN
o Starting an IV
o Hanging or mixing IV meds
o IV push meds
