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Case Studies for Prioritization Practice Case Study 1 Rachel is a…
Case Studies for Prioritization Practice
Case Study 1
Rachel is a medical-surgical nurse that has been practicing for two years in her unit. Today, she has been asked to work in the emergency department (ED) and has the following patients. In what order should she see the following patients, and why?
? A 10-year-old with a 2 cm laceration to her left arm. The laceration is bleeding through a 4 X 4 gauze every 5-10 minutes.
? A 21-year-old with complaints of a “migraine headache,” vomiting, pain (9 out of 10), and unable to open their eyes due to light sensitivity.
? A 62-year-old male with COPD and increased difficulty breathing for the past two hours. His family reports a recent cold and significant worsening in the past 24 hours.
? A 45-year-old female with chest pain that is talking on her cell phone to her son as she is being checked in.
Case Study 2
Jill is a travel nurse that went through a four-hour orientation to the unit she is working on today. She is receiving report on the six patients she will have for the shift. Which of the following actions should be a
priority?
? Ensure that she has access to the computer system and medication dispensing system on the
unit.
? Develop a schedule for lunch and breaks in collaboration with the other staff.
? Request a bedside report rather than the current reporting system at this facility, since this is what she is used to.
? Ensure that she knows where the policy and procedure manual is located.
? Identify a contact person on the unit that can provide information if needed.
Case Study 3
Stacy has been a nurse for six months and was just released from orientation on her unit. She has seven patients today. The following reports were given about her patients. Which patient should she see first?
? A 42-year-old cholecystectomy patient that is four hours post-op and having uncontrolled pain.
? A 26-year-old newly diagnosed type 1 diabetic with a blood sugar of 320.
? A 19-year-old patient who attempted suicide with acetaminophen (Tylenol) last night and is being transferred to a psych unit this afternoon.
? An 82-year-old Alzheimer’s patient with increased confusion and right-sided weakness that started approximately an hour ago.
? A 60-year-old female who had a myocardial infarction (MI) last night and is going to surgery in one hour.
Case Study 4
Kyle is on a four-week assignment at a level 1 trauma center as a CCU nurse. He is in his second week
and feels comfortable with the unit and the staff. He has two patients. Patient A is a 46-year-old male
who is 12 hours status-post-CABG and patient B is a 32-year-old female who had a motor-vehicle-
accident (MVA) 36 hours ago and has multiple fractures and flail chest. Please place the following tasks
related to their care in the most appropriate order.
? Morning assessments.
? Administer PRN pain medication to patient B.
? Take report from the night nurse.
? Adjust patient A’s medications based on the doctor’s orders and the most recent set of lab results.
? Call the healthcare provider about patient B’s morning lab results.
? Review the medication administration record (MAR) and create a medication administration
schedule for both patients.
? Empty the Jackson-Pratt (JP) drains in patient A’s chest.
? Personal care (bath, oral care, and change clothing) for both patients.
Case Study 5
Josh is working on a pediatric unit today and has six patients. He is working with a care team that
includes an unlicensed assistive personnel (UAP), a licensed practical nurse (LPN), and a respiratory
therapist (RT) on call. The following patients and diagnoses are assigned to him:
? A six-year-old returning from tonsillectomy needing PRN intramuscular (IM) or oral (PO) pain
medication.
? A four-year-old with an asthma exacerbation needing their respiratory treatment.
? A 10-month-old who is post-surgery for pyloric stenosis needing a bath.
? A 12-year-old who had a four-wheeler accident two days ago resulting in a fractured femur and
multiple wounds who needs a dressing change to a wound on their arm.
? A 14-year-old who is 12-hours post-appendectomy after a rupture complaining of nausea.
? A four-month-old with respiratory syncytial virus (RSV) needing their nose cleared of drainage.
Consider the following:
1. Which patient(s) would be appropriate to delegate to the UAP?
2. Which patient(s) would be appropriate to delegate to the LPN?
3. Which patient(s) would be appropriate to call RT?
4. Which patient should Josh see first, and why?
Case Study 6
John is an agency nurse who is assigned to an acute care unit in a long-term care facility. He receives a report on his patients for the day. Who should he assess first after receiving report?
? A resident with congestive heart failure (CHF) with 3+ pitting edema in their bilateral lower
extremities.
? A resident with Parkinson’s disease (PD) that started hallucinating during the night and is
sleeping now.
? A resident with Alzheimer’s disease (AD) that was wandering in the hallway at 2 am.
? A resident with terminal cancer who the UAP reported has lost eight pounds since their last
weight check four weeks ago.
Case Study 7
Chris is a new nurse on the medical-surgical unit, and today is his first shift since completing his
orientation. He is caring for a patient that weighs 425 pounds with MS who is minimally responsive. The
UAP asks for assistance in moving the patient in the bed. Which of the following actions would be most appropriate?
? Refuse to move the patient since their weight is this high.
? Tell the family that the patient will need to assist with repositioning in bed.
? Get another nurse or UAP to help move the patient in bed.
? Obtain a lifting device that will accommodate a patient of this weight
Case Study 8
Nurse Amy has an LPN and UAP on her care team to assist with patient care. Which of the following
tasks would be appropriate to delegate to the LPN? Which would be appropriate to delegate to the
UAP?
? Assist a patient with MS to ambulate to the bathroom.
? Assess a newly admitted patient with pneumonia.
? Take the initial vital signs while administering a unit of blood to a patient.
? Administer a vitamin B12 injection to a patient with pernicious anemia
