Question

The licensed practical nurse is assessing several clients assigned to his care. Which client should receive priority of care? A. A 65-year-old client with emphysema with an oxygen saturation level of \(82 \%\) B. A 45-year-old motor vehicle accident client with chest tubes and a \(\mathrm{CO}_2\) level of \(48 \mathrm{mE} / \mathrm{L}\) C. An 80-year-old diabetic with a blood glucose level of \(430 \mathrm{mg} / \mathrm{dl}\) D. A 50-year-old client with cirrhosis of the liver and a blood urea nitrogen level of \(35 \mathrm{mg} / \mathrm{dl}\)

Short answer

Answer: A. A 65-year-old client with emphysema with an oxygen saturation level of 82%.

Step-by-step solution

Understanding the conditions

To determine which client needs priority, we need to understand the severity of each condition and the given vital signs: oxygen saturation level, CO2 level, blood glucose level, and blood urea nitrogen level.

Analyzing each choice

A. A 65-year-old client with emphysema with an oxygen saturation level of \(82 \%\): Emphysema is a serious lung condition that causes shortness of breath and reduced oxygen levels. A normal oxygen saturation level is \(95 \%\) to \(100 \%\). An oxygen saturation level of \(82 \%\) indicates that the client is not getting enough oxygen, which could be life-threatening. B. A 45-year-old motor vehicle accident client with chest tubes and a \(\mathrm{CO}_2\) level of \(48 \mathrm{mE} / \mathrm{L}\): The normal CO2 level should be around \(35 \mathrm{mE} / \mathrm{L}\) to \(45 \mathrm{mE} / \mathrm{L}\). This client's CO2 level is slightly elevated, but it may not be life-threatening. The presence of chest tubes indicates that the client has already received some level of emergency care. C. An 80-year-old diabetic with a blood glucose level of \(430 \mathrm{mg} / \mathrm{dl}\): A normal blood glucose level is around \(70 \mathrm{mg} / \mathrm{dl}\) to \(130 \mathrm{mg} / \mathrm{dl}\). A level of \(430 \mathrm{mg} / \mathrm{dl}\) is significantly elevated, but it may not be life-threatening in the short term if the patient receives treatment. D. A 50-year-old client with cirrhosis of the liver and a blood urea nitrogen level of \(35 \mathrm{mg} / \mathrm{dl}\): The normal range for blood urea nitrogen is approximately \(7 \mathrm{mg} / \mathrm{dl}\) to \(20 \mathrm{mg} / \mathrm{dl}\). A level of \(35 \mathrm{mg} / \mathrm{dl}\) is elevated but may not be life-threatening in the short term.

Determining the priority

After analyzing each choice, it's clear that the 65-year-old client with emphysema and an oxygen saturation level of \(82 \%\) is the most critical and requires immediate attention. Breathing issues and low oxygen saturation can be life-threatening, and the other clients' conditions, while serious, may not require immediate, life-saving interventions. Therefore, the correct answer is: A. A 65-year-old client with emphysema with an oxygen saturation level of \(82 \%\)

Key concepts

Nursing Assessment

In nursing, the assessment process is a pivotal step to understand a patient's current health status and needs. Begin by gathering comprehensive data through observation and communication.
o Assess physical conditions, vital signs, and potential symptoms.

• Monitor parameters like oxygen saturation, blood glucose, and CO2 levels.
• Identify unusual or alarming patterns that might signal a change in patient status.

The nurse's role is to collect, interpret, and act on this data to develop a care plan.
This structured evaluation allows the nurse to pinpoint immediate concerns, determine the severity of health issues, and chart out the next steps for intervention.

Patient Care Prioritization

Prioritizing patient care involves determining which patient needs immediate attention. In scenarios where multiple patients show distinct symptoms, it’s crucial to decide based on the acuity of their conditions.
Prioritize by:

• Identifying life-threatening conditions or deteriorating patients first.
• Evaluating the risk to vital functions such as breathing, circulation, and consciousness.
• Considering both the severity and the immediacy of required care.

The primary aim is to stabilize critical conditions swiftly to prevent mortality or further health degradation.
By applying prioritization principles, nurses can effectively manage their time and resources to improve patient outcomes.

Clinical Judgment

Clinical judgment in nursing is the ability to make informed decisions and take appropriate actions based on assessed data and experience. It is a skill honed over time.
To develop sound clinical judgment, nurses analyze:

• Signs and symptoms of each patient.
• Risk factors for adverse outcomes.
• The best evidence for intervention strategies.

Critical thinking plays a central role, enabling nurses to anticipate complications and act proactively.
Effective clinical judgment leads to better prioritization, appropriate interventions, and enhanced patient safety and care quality.

Life-Threatening Conditions

Life-threatening conditions are medical states in which immediate risk to life exists, necessitating urgent intervention.
Key features to recognize these conditions include:

• Severe breathing difficulties, low oxygen saturation levels, and abnormal vital signs.
• Signs of shock, hemorrhage, or rapidly deteriorating consciousness.
• A high probability of irreversible harm if not treated immediately.

In the context of healthcare priority setting, recognizing these conditions is vital.
Swift identification and rapid response can drastically reduce morbidity and mortality, highlighting the importance of readiness and training among healthcare providers.