This is your first week as an RN in a small rural hospital. You work the night shift on a medical-surgical unit. Tonight your only unlicensed assistive personnel (UAP) and a staff nurse have called in sick, which makes the unit short-staffed. You have notified the night supervisor that you need help, and she sends a USP from another floor to assist you. She tells you she can send another nurse in about an hour, and instructs you to take care of the priority cases until that time.
You have six relatively uncomplicated patients; caring for them involves checking their vital signs and giving medications. You instruct the aide to obtain vital signs for these patients and report the results back to you. A quick review of the medications reveals nothing that is urgent; you can wait and have the second nurse administer the medications when he or she arrives. You have four other patients with more complicated issues, who require additional assessments and urgent care:
• George Patel, a 64-year-old patient with a tracheostomy, has gurgling sounds coming from his tracheostomy and a frequent, nonproductive cough. His oxygen saturation level via pulse oximetry is 88%. You have orders to suction his tracheostomy prn.
• Gwen Galloway had been receiving chemotherapy and has now come back to the hospital with gastroenteritis. When you arrive on your shift, she is experiencing bouts of nausea and vomiting.
• Claudia Tran, an 84-year-old patient from a skilled nursing unit, is post-CVA. She has a stage III pressure injury on her coccyx and a stage I pressure injury on her left hip. She needs to be turned every 30 minutes because of rapidly developing erythema on bony prominences. She is confused and has fallen the past two nights when left unattended, even with implementation of fall precautions. Her family is visiting her now but plans to leave in 30 minutes.
• James White has COPD. The UAP reports that the blood pressure from the automatic cuff is 168/100 mm Hg; his baseline is usually 130/70 mm Hg. The UAP also reports that he is complaining of a severe headache, but has no other complaints.
Identify the order in which you would provide care to these patients. Explain your rationales as well as your interventions.
