Question

The nurse employed in the emergency room is responsible for triage of four clients injured in a motor vehicle accident. Which of the following clients should receive priority in care? A. A 10-year-old with lacerations of the face B. A 15-year-old with sternal bruises C. A 34-year-old with a fractured femur D. A 50 -year-old with dislocation of the elbow

Short answer

Answer: The 34-year-old with a fractured femur (Option C) should receive priority in care.

Step-by-step solution

Identifying Severity of Injuries

In this step, we will identify the severity of injuries for each client and their potential complications. A. Lacerations of the face - moderate injury; may lead to significant blood loss, pain, and scarring. B. Sternal bruises - mild injury; may cause pain and temporary breathing difficulty, but generally not life-threatening. C. Fractured femur - severe injury; can lead to significant blood loss, shock, and long-term complications if not treated immediately. D. Dislocation of the elbow - moderate injury; may cause pain, swelling, and loss of function, but typically not life-threatening.

Evaluating Age and Vulnerability

In this step, we will consider the age of each client and their overall level of vulnerability to injury complications. A. 10-year-old - young and generally resilient, but more vulnerable due to the developmental stage. B. 15-year-old - still developing but less vulnerable than a younger child. C. 34-year-old - young adult with average vulnerability to complications D. 50-year-old - older adult with potentially increased vulnerability due to age

Prioritizing Care

Now that we have evaluated the severity of each injury and the vulnerability of each client, we can prioritize care accordingly. 1. The 34-year-old with a fractured femur should receive priority care due to the severity of this injury and the high risk of blood loss and shock if not treated immediately. 2. The 10-year-old with lacerations of the face should receive care next due to their level of vulnerability and the need to minimize blood loss and pain. 3. The 50-year-old with dislocation of the elbow should be attended to next, as this injury is moderately severe and they may have increased vulnerability due to their age. 4. The 15-year-old with sternal bruises should receive care last, as their injury is the least severe and they are less vulnerable than the younger child. In conclusion, the client who should receive priority in care is the 34-year-old with a fractured femur (Option C).

Key concepts

Severity of Injuries Assessment

In an emergency room setting, assessing the severity of injuries quickly is essential for effective triage. Nurses evaluate each patient's condition to determine which injuries require immediate attention. Certain injuries have indicators that help determine their severity:

• Lacerations: Facial lacerations, like in option A, may appear urgent due to significant bleeding and cosmetic concerns, though not typically life-threatening.
• Bruises: Sternal bruises, as in option B, often cause discomfort but rarely pose a severe threat.
• Fractures: A fractured femur, option C, can be quite serious. It often involves major arteries, leading to potential blood loss and shock, elevated in severity.
• Dislocations: Dislocations, like an elbow dislocation in option D, cause pain and temporary dysfunction but are not usually life-threatening without complications.

Understanding these parameters allows nurses to systematically gauge the urgency of each case and proceed with the most critical interventions first.

Nursing Prioritization

Nursing prioritization is the process of determining the order of treatments based on patient need. In emergency situations, quick and accurate prioritization is crucial to patient outcomes. Different factors include:

• Severity of Injury: More severe and life-threatening conditions, such as the fractured femur noted in option C, receive top priority for immediate intervention.
• Age and Vulnerability: Younger patients or those at developmental stages, like the 10-year-old in option A, are deemed particularly vulnerable and may be prioritized to prevent long-term effects.
• Resource Availability: The availability of resources, including personnel and equipment, can affect how nurses prioritize care.

These elements guide decisions to ensure resources and time are directed where they have the most significant impact.

Emergency Room Procedures

Emergency room procedures are very structured, revolving around efficiency and efficacy to address a wide variety of ailments. Once patients arrive, the triage system helps organize care based on severity. Here’s how the process typically unfolds:

• Initial Assessment: This includes taking vital signs and assessing visible injuries.
• Triage: Nurses determine priority using established criteria, just as assessed in the previous examples.
• Care Implementation: Prompt intervention for high-priority cases, such as managing shock or setting a fractured femur, is initiated.
• Documentation: Every step, from injury assessment to care decisions, is documented to ensure continuity of care.
• Re-evaluation: Continuous monitoring and re-evaluation ensure that any changes in patient condition are addressed swiftly.

These procedures are designed to maximize patient safety and optimize healthcare delivery in a high-stakes environment.