Question

The nurse is making rounds. Which client should be seen first? A. The 78-year-old who had a gastrectomy 3 weeks ago and has a PEG tube B. The 5-month-old discharged 1 week ago with pneumonia who is being treated with amoxicillin liquid suspension C. The 50-year-old with MRSA (methcillin-resistant staphylococcus aurea) D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone intravenously

Short answer

Answer: The nurse should prioritize attending to the 50-year-old patient with MRSA (C) first due to the urgency, severity, and infectious nature of the condition.

Step-by-step solution

Understanding the Medical Conditions and Treatments

The first step to solving this is understanding the medical conditions and treatments presented in the problem: (A) Gastrectomy is a procedure where a part or all of the stomach is surgically removed. A PEG tube (Percutaneous Endoscopic Gastrostomy) is a way to provide nutrition to patients who cannot eat orally. (B) Pneumonia is a type of infection that inflames the air sacs in one or both lungs which may fill with fluid. Amoxicillin is a type of antibiotic used to treat such infections. (C) MRSA (Methicillin-resistant Staphylococcus aureus) is a type of bacteria that's resistant to several antibiotics. In the healthcare settings, MRSA can cause severe problems such as bloodstream infections. (D) Multiple Sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. Cortisone is used for its anti-inflammatory effects in the active phases of MS. Intravenous treatment is usually given in the case of serious MS relapses.

Prioritizing Based on Urgency and Severity

Now that you understand the conditions, the next step is to prioritize based on the urgency and risk associated with each condition: (A) The 78-year old patient with gastrectomy: If the patient is stable, they could probably wait a little longer. (B) The 5-month old with pneumonia: Babies have weaker immune systems, making them more vulnerable to complications and less able to fight off infections. So, this patient should be a priority. (C) The 50-years old with MRSA: MRSA can be extremely serious, it is a superbug that is resistant to normal antibiotics. Such patients could deteriorate quickly and should be a high priority due to the infectious nature of the disease. (D) 30-year-old with MS: If this patient is in exacerbation (flare-up), he could need immediate help, as cortisone IV is usually given for serious attacks, it indicates the patient is having severe symptoms.

Final Assessment

Based on the severity and urgency associated with their situations, the MRSA patient (C) and the MS patient (D) might be the ones in more immediate need of attention. However, due to the infectious nature of MRSA, patient C should be prioritized over patient D to avoid the risk of transmission to other patients. After assessing all the given conditions, the patient with the most critical need is the 50-year-old with MRSA (C). Therefore, the nurse should see this client first.

Key concepts

Nursing Prioritization

Nursing prioritization is a critical skill for managing patient care effectively. It involves making decisions about the order in which to attend to patients, based on the urgency of their conditions and the resources available. When faced with multiple patients, nurses must quickly assess each one's situation to determine who requires immediate attention.

For instance, in the exercise scenario, nurses are required to make a judgement call among patients with diverse medical needs. A stable post-operative patient with a PEG tube might be lower in priority compared to patients with conditions that could rapidly deteriorate, like MRSA or a severe MS exacerbation.

Such decisions are generally guided by principles like the ABCs (airway, breathing, circulation), the potential for rapid deterioration, and the risk of infection to others. The decision-making process often involves clinical judgement, understanding of medical treatments, and experience. Despite the complexities, the goal remains clear: to ensure the safety and well-being of all patients under the nurse's care.

Patient Care Scenarios

Patient care scenarios in nursing are structured to simulate a real-world environment where nurses must tackle multiple challenges and patient needs. These scenarios require understanding the patient's history, current condition, and the appropriate interventions that should be taken in the clinical setting.

Considering the exercise, each patient represents a unique scenario that requires specific knowledge and action. For example, the 5-month-old with pneumonia needs careful monitoring as infants are more susceptible to complications. Whereas, the patient with MRSA poses a considerable risk for spreading a serious infection, demanding isolation measures on top of the medical treatment.

Effective handling of patient care scenarios relies on a nurse's ability to communicate, coordinate with a health care team, and prioritize tasks. Continuous training and simulation exercises are crucial means of preparing nurses to manage such scenarios proficiently and confidently.

Medical Conditions and Treatments

Medical conditions and their treatments are central to nursing practice. A deep understanding of these allows for appropriate care and prioritization. Different conditions have distinct levels of urgency and treatment protocols.

In the given exercise, conditions range from infectious diseases to chronic, potentially disabling illnesses. Treatments can be as varied as antibiotics, surgeries, and long-term medications like cortisone for MS flares. Each treatment has its own set of side effects and required monitoring. For instance, an MRSA infection necessitates the use of specific antibiotics and strict infection control practices, while cortisone therapy for an MS patient involves watching for immune suppression and hormone imbalance effects.

Nurses must stay informed about current medical treatments and protocols to provide safe and effective patient care. This continuous learning is vital not only for the nurse's professional development but also for the safety and improvement of patient outcomes.