Ch 18 Prioritization

Strategies to improve productivity

Create more personal times, use downtime, control unwanted distractions, find personal time for lifelong learning

You have received report on the following patients. Who would you make patient care rounds on first? A. Patient who is concerned that he has had no bowel movement for two days. B. Patient who has suffered several acute asthmatic attacks within the last 24 hours. C. Patient who is now comfortable but has had several episodes of breakthrough pain since yesterday. D. Patient who is severely allergic to peanuts who just ate potato chips fried in peanut oil.

D. Patient who is severly allergic to peanuts who just ate potato chips fried in peanut oil.

End of Shift Report

Demographics, dx, pt status, fluids/tubes/oxygen/lab tests/proceedures, expected shift outcomes, plans for discharge, care support, priority interventions

the best possible objectives to be achieved given the resources at hand

Desired Optimal Outcomes

Priority order

1. Life threatening conditions 2. Potentially life threatening conditions 3.Activities Essential to Safety 4.Comfort, Healing, Teaching

The nurse has been assigned to a medical-surgical unit on a stormy day. Three of the staff can't make it in to work, and no other staff is available. How will the nurse proceed? Select all that apply. A. Prioritize care so that all patients get safe care. B. Provide nursing care only to those patients to whom the nurse is regularly assigned. C. Have the patients' families and ambulatory patients take care of the other patients. D. Refuse the nursing assignment, as the increased number of patients makes it unsafe. E. Quickly make rounds on all assigned patients to assess needs. F. Decide on desired outcomes.

A, E, F

A nurse can enhance personal productivity by doing which of the following? Select all that apply. A. Analyzing time, getting up an hour early, and delegating unwanted tasks. B. Getting up an hour early, answering the phone, and inviting a friend in to talk. C. Analyzing use of time, getting up early, and waiting patiently. D. Avoiding working and going to school at the same time. E. Controlling unwanted distractions such as texts, e-mails, and unplanned phone calls. F. Using downtime by having reading and writ- ing materials available.

A, E, and F

Of the following new patients, who should be assessed first by the nurse? A. A patient with a diagnosis of alcohol abuse with impending delirium tremens (DTs). B. A patient with a newly casted fractured fibula, complaining of pain. C. A patient admitted two hours ago who is scheduled for a nephrectomy in the morning. D. A patient diagnosed with appendicitis who has a temperature of 37.8°C (100.2°F) orally.

A. A patient with a diagnosis of alcohol abuse with impending delirium tremens (DTs)

The staff RN's assignment on the 7 a.m. to 3 p.m. shift includes a newly admitted patient with pneumonia who has arrived on the unit, a new postoperative surgical patient requesting pain medication, and a patient diagnosed with nephrolithiasis who is complaining of nausea. What should the nurse do first after shift report? A. Assess the newly admitted pneumonia patient. B. Give morphine to the new postoperative patient. C. Set up the 9 a.m. medications. D. Administer Zofran (Ondansetron hydrochloride) to the patient complaining of nausea.

A. Assess the newly admitted pneumonia patient

Who would you make rounds on second? A. Patient who is concerned that he has had no bowel movement for two days. B. Patient who has suffered several acute asthmatic attacks within the last 24 hours. C. Patient who is now comfortable but has had several episodes of breakthrough pain since yesterday. D. Patient who is severely allergic to peanuts who just ate potato chips fried in peanut oil.

B. Patient who has suffered several scute asthmatic attacks within the last 24 hours

The nurse has just finished the change of shift report. Which patient should the nurse assess first? A. A postoperative cholecystectomy patient who iscomplaining of pain but received an IM injection of morphine five minutes ago. B. A postoperative appendectomy patient who will be discharged in the next few hours. C. A patient with asthma who had difficulty breathing during the prior shift. D. An elderly patient with diabetes who is on the bedpan.

C. A patient with ashtma who had difficulty breathing during the prior shift

A new graduate RN organizing her assignment asks the charge nurse, "Of the list of patients assigned to me, who do you think I should assess first?" What is the best response the charge nurse could make? A. "Check the policy and procedure manual for whom to assess first." B. "Assess the patients in order of their room number to stay organized." C. "I would assess the patient who is having respiratory distress first." D. "See the patient who takes the most time last."

C. I would assess the patient who is having respiratory distress first

The nurse has just come on duty and finished hearing morning report. Which patient will the nurse see first? A. The patient who is being discharged in a few hours. B. The patient who requires daily dressing changes. C. The patient who is receiving continuous IV Heparin per pump. D. The patient who is scheduled for an IV Pyelogram this shift

C. The patient who is receiving continuous IV Heparin per pump

The nurse has just completed listening to morning report. Which patient will the nurse see first? A. The patient who has a leaking colostomy bag. B. The patient who is going for a bronchoscopy in two hours. C. The patient with a sickle cell crisis and an infiltrated IV. D. The patient who has been receiving a blood transfusion for the past two hours and had a recent hemoglobin of 7.2 grams/dL.

C. The patient with a sickle cell crisis and infiltrated IV

Priority traps to avoid

Doing whatever hits first Taking the path of least resistance Responding to the squeaky wheel Completing tasks by default Relying on misguided inspiration