Prioritization Case Study
You are working night shift on a medical/surgical unit caring for 8 patients.
There is another nurse on the unit that has a similar assignment. There is
one nurse’s aide on the unit to help both of you.
Below is the list of your patients with their diagnosis, PMH as well as the
admitting MD:
Patient Age
Admitting Diagnosis
PMH
Doctor
84 year old
62 year old
77 year old
82 year old
44 year old
88 year old
57 year old
68 year old
confused w/urosepsis
CVA: right hemiparesis
c/o weakness
GI bleed
3 days s/p colectomy
CHF
chronic pancreatitis
newly dx Type II DM
CAD, dementia
HTN, DM Type II
No significant PMH
Ulcerative Colitis, stress
Crohn’s Disease
CAD, HTN, MI x 2
ETOH,
Depression,
Dr. C. M. Pea
Dr. C.T. Scanner
Dr. Ima Guessin
Dr. U. L. Ceration
Dr. Kuttem
Dr. Dryem
Dr. Paenfle
Dr. Sweeten



What are your initial priorities for each one of these patients?
What information would you need to obtain on assessment of each
of these patients?
What medications (classifications) do you anticipate finding on
each patients MAR?
Throughout the shift, things may (probably will ) happen that the MD will
need to be notified about…
Decide what information you will want to have prior to calling the
doctor…what will you want to assess prior to making the call and be sure
to think SBARR.
62 year old patient with a CVA: right hemiparesis; Dr. C.T. Scanner
0010
You finally get in to see this patient and you have difficulty arousing her.
She barely arouses to painful stimuli. You notice that she has minimal
movement of all extremities and her vocalizations are unintelligible. Her
midnight vitals were BP 210/122, HR 88, RR 12 and Temp of 36.8°
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com
77 year old patient with c/o weakness; Dr. Ima Guessin
0100
This patient is complaining of not being able to get to sleep. He states
that he usually takes something at home every night to help him sleep.
He wants you to call the doctor and get something for him.
84 year old confused patient with urosepsis; Dr. C. M. Pea
0210
Aide comes to tell you that the patient is very confused, trying to get out
of bed…”was a little confused at the beginning of the shift but nothing like
this”. The patient is now screaming that people are ‘trying to kill him’ and
waking up all the other patients on the unit. You need to notify the doctor
of this change…what are you going to tell him/her? Unable to get vital
signs or assessment at this time.
88 year old patient with CHF; Dr. Dryem
0245
The patient calls you in to tell you that she is having difficulty ‘getting
enough air’. You notice that her respirations are much more labored and
wet sounding than your earlier assessment.
82 year old patient with GI bleed; Dr. Butts
0330
The aide tells you that she just got this patient back to bed after needing
to use the bathroom. The patient was weak and shaky on the way back
to bed, stating he thought he was going to pass out. Now feels better
after lying down. His vitals were stable at midnight.
44 year old patient 3days s/p colectomy; Dr. Kuttem
0400
The aide comes to tell you that the patient’s vital signs are really different
than when she took them at midnight. The temperature is now 103.8 with
a pulse of 126.
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com
57 year old patient with chronic pancreatitis; Dr. Paenfle
0430
The aide comes to tell you that your patient is getting dressed in the room
and says he is ‘going home’ because he can’t get enough pain relief
here. You are unable to give more pain medication at this time. The
patient wants to sign out AMA unless something is done.
68 year old patient with newly diagnosed Type II DM; Dr. Sweeten
0545
The aide comes to tell you that the patient’s CBG is 408 and the patient is
really sleepy. You have an order for sliding scale insulin coverage but the
order says to notify the MD for any blood glucose > 400.
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com