Question

The nurse is triaging four clients injured in a train derailment. Which client should receive priority treatment? A. A 42-year-old with dyspnea and chest asymmetry B. A 17-year-old with a fractured arm C. A 4-year-old with facial lacerations D. A 30-year-old with blunt abdominal trauma

Short answer

Answer: The 42-year-old with dyspnea and chest asymmetry (option A) should receive priority treatment as their condition is most severe and requires immediate intervention to save their life.

Step-by-step solution

Assess the severity of each client's injury

In this step, we will evaluate the severity of each patient's condition based on their symptoms. A. A 42-year-old with dyspnea (shortness of breath) and chest asymmetry B. A 17-year-old with a fractured arm C. A 4-year-old with facial lacerations D. A 30-year-old with blunt abdominal trauma

Evaluate which injury requires immediate attention

We need to assess which injury poses the most significant risk to the patient and if left untreated, which injury could lead to severe complications or death. A. Dyspnea and chest asymmetry could indicate a tension pneumothorax, which can quickly become life-threatening if not treated promptly. B. A fractured arm is painful and requires treatment, but it is not life-threatening. C. Facial lacerations need to be cleaned and stitched, but they are not life-threatening unless the bleeding cannot be controlled. D. Blunt abdominal trauma can be severe and life-threatening but can sometimes require additional diagnostic testing to determine the extent of the injury, which might take more time.

Determine the client's priority for treatment

Considering the severity and urgency of each client's injury, the following prioritization can be established: 1. A 42-year-old with dyspnea and chest asymmetry should receive priority treatment, as their condition is most severe and needs immediate intervention to save their life. 2. A 30-year-old with blunt abdominal trauma should receive the second priority, as their condition can become life-threatening and requires timely intervention. 3. A 4-year-old with facial lacerations should receive the third priority, as their injury needs treatment but is not life-threatening. 4. A 17-year-old with a fractured arm should receive the fourth priority, as their injury requires treatment but is not life-threatening.

Conclusion

Based on the severity and urgency of each patient's injury, the 42-year-old with dyspnea and chest asymmetry (option A) should receive priority treatment after the train derailment.

Key concepts

Triage Priority Assessment

Understanding how to quickly and efficiently assess the severity of patients' injuries or conditions in a critical situation is a cornerstone of emergency nursing care. Triage priority assessment is a process used by nurses and other healthcare professionals to determine which patients need immediate attention and in which order.

In emergency scenarios like a train derailment, triage is applied by categorizing patients based on the urgency of their needs. This sorting allows for the most efficient use of available resources to save lives and reduce the risk of complications.

Triage Levels

• Immediate (Red): Life-threatening injuries requiring immediate treatment to save life or limb.
• Delayed (Yellow): Serious injuries but not immediately life-threatening; patients require observation and eventual treatment.
• Minor (Green): Injuries are non-life-threatening; patients can wait for longer periods before receiving medical care.
• Expectant (Black): Injuries so severe that survival is unlikely even with medical intervention; focus may be on palliative care.

For instance, in the exercise provided, a 42-year-old with dyspnea and chest asymmetry suggestive of tension pneumothorax could deteriorate rapidly, making them an immediate, or Red, priority. The triage nurse's role is also to ensure that each patient is reassessed periodically to identify any changes in their condition which might alter their triage category.

Emergency Nursing Care

Emergency nursing care involves the initial assessment and stabilization of patients in urgent medical situations. Nurses working in emergency settings must be skilled in recognizing life-threatening conditions, providing timely care, and making quick decisions regarding patients' needs.

The emergency nurse's goal is to stabilize a patient's vitals, manage pain, prevent complications, and assist in interventions that could save lives or limbs.

Key Components of Emergency Nursing Care

• Initial Assessment: Gathering crucial information to determine the severity of the condition, which includes vital signs, level of consciousness, and presence of life-threatening injuries.
• Rapid Intervention: Performing or assisting in procedures like airway management, bleeding control, or preparing for emergency surgery.
• Continuing Assessment: Monitoring patients continuously for changes in their condition and responding appropriately.
• Triage Reassessment: Re-evaluating patients' conditions to ensure the accuracy of triage decisions as situations evolve.

In the given exercise, the emergency nurse's assessment and subsequent actions directly impact the 42-year-old's survival, making a timely and accurate assessment critical.

NCLEX-RN Examination Preparation

The NCLEX-RN exam is a significant hurdle for nursing students to become licensed practitioners in the United States. The exam tests knowledge, skills, and abilities essential for safe and effective practice as an entry-level nurse. Preparation for the NCLEX-RN involves a comprehensive review of concepts, including triage priority assessment and emergency nursing care.

Strategies for NCLEX-RN Preparation

• Understand the Test Format: The NCLEX-RN uses a computerized adaptive testing approach that adjusts the difficulty of questions based on the examinee's ability.
• Review Core Content: Focus on mastering topics like pharmacology, medical-surgical nursing, pediatrics, maternity, and psychiatric nursing.
• Practice with Simulation Questions: Engage in practice questions that mimic the style and complexity of the NCLEX-RN to build familiarity and confidence.
• Study Consistently: Develop a study plan and schedule that allows for consistent review over time rather than last-minute cramming.
• Manage Test Anxiety: Learn relaxation and time management techniques to help ease anxiety and maintain focus during the exam.

Applicants are encouraged to solve problems similar to the triage priority exercise provided, as such scenarios assess critical thinking and the application of nursing principles vital for the exam.