Prioritization, Delegation, and Staff Management Notes

Prioritization

• Prioritization in NCLEX depends on the number of patients.
• Three methods:
  • Maslow's Hierarchy of Needs: Use when you have one patient with multidimensional needs.
  • ABCs (Airway, Breathing, Circulation): Use when you have one patient with primarily physical needs.
  • Stable vs. Unstable: Use when you have four different patients.
• For four patients, initially use stable vs. unstable before considering Maslow or ABCs.

Stable vs. Unstable

• Focus on determining which patients are stable and which are unstable.
• Each answer in NCLEX questions typically includes four parts:
  • Age
  • Gender
  • Diagnosis/Surgery
  • Modifying Phrase
• Ignore the age and gender of the patient to avoid discrimination or bias.
• Prioritize based on diagnosis and, most importantly, the modifying phrase.
• Modifying phrase is more important than the diagnosis.
  • Example: Angina with unstable vital signs is higher priority than myocardial infarction (MI) with stable vital signs.

Rules for Prioritization: Stable vs. Unstable

Stable

1. Use of the Word "Stable": If the patient is described as stable, consider them stable.
2. Chronic Illness: Patients with chronic illnesses are generally considered stable.
   • Examples: COPD, CHF, chronic renal failure.
3. Regional or Local Anesthesia: Patients who have undergone procedures with regional or local anesthesia are stable.
4. Post-Op (Greater Than 12 Hours): Patients more than 12 hours post-operative are typically stable.
5. Admitted Longer Than 24 Hours: Patients admitted longer than 24 hours ago are generally stable.
6. Lab Values (A's and B's): Stable lab values (typically A's and B's) indicate a stable patient.
7. No Change: When there are no recent changes in condition.
8. Expected Signs and Symptoms: Experiencing expected signs and symptoms of their diagnosed disease.
   • Example: Angina pectoris with crushing chest pain.
   • Example: Hepatitis with jaundice
9. Evidence Treatment is Working: Evidence that the treatment is working.
   • Example: Pneumonia patient who is afebrile while recieving treatment.

Unstable

1. Use of the Word "Unstable": If the patient is described as unstable, consider them unstable.
2. Acute Illness: Patients with acute illnesses are generally unstable.
   • Example: Acute appendicitis.
3. General Anesthesia: Patients who have undergone general anesthesia are unstable.
4. Post-Op (Less Than 12 Hours): Patients less than 12 hours post-operative are typically unstable.
5. Admitted Less Than 24 Hours: Newly admitted or newly diagnosed patients (less than 24 hours) are generally unstable.
6. Lab Values (C's and D's): Unstable lab values (typically C's and D's) indicate an unstable patient.
7. Changing: When there are recent changes condition of the patient.
8. Unexpected Signs and Symptoms: Experiencing unexpected signs and symptoms (complications).
   • Example: Angina pectoris with jaundice is unstable.
   • Example: Hepatitis patient with crushing chest pain is unstable.
9. Evidence Treatment is Not Working: Evidence that treatment is not working.
   • Example: A person on a beta blocker whose pulse is $200$.

Always Unstable (Regardless of Other Factors)

• Hemorrhage: Patients who are hemorrhaging are always unstable.
• Hypoglycemia: Patients with low blood glucose levels are always unstable.
• Hyperpyrexia: Patients with fevers over $104$°F are always unstable.
• Pulselessness or Breathlessness: Patients without a pulse or who are not breathing are always unstable.

Tiebreaker

• Used when two answers seem correct.
• The more vital the organ, the higher the priority.
• Order of organ vitality:
  1. Brain
  2. Lung
  3. Heart
  4. Liver
  5. Kidney
  6. Pancreas
• Example: An unstable brain condition is higher priority than an unstable lung condition.