Which patient do you see first

1 · AIRWAY — A client with a new tracheostomy has high-pitched crowing on inspiration and is restless. Stridor with restlessness is airway obstruction until proven otherwise, and it outranks every other client on this list.

2 · BREATHING — A client receiving opioid analgesia by patient-controlled pump on the day of surgery has a respiratory rate of eight and is difficult to rouse. Sedation precedes respiratory arrest. The drop in responsiveness is the finding, not the rate on its own.

3 · PERFUSION — A client two days after hip arthroplasty reports sudden sharp chest pain on inspiration with new shortness of breath. Sudden onset plus immobility plus pleuritic pain is an embolic pattern.

4 · NEURO — A client with a head injury shows a widening pulse pressure, a falling heart rate, and irregular respirations. This triad indicates rising intracranial pressure. It is a late sign, so it is urgent rather than reassuring.

5 · POST-SURGICAL — A client after thyroidectomy reports tingling around the mouth and in the fingertips. Suggests hypocalcemia from parathyroid disturbance, and it can progress to laryngospasm.

6 · INFECTION — A child with sickle cell disease has a fever. Functional asplenia makes fever a sepsis emergency, not a routine finding.

7 · LOOKS URGENT, IS NOT — A client on the second postoperative day has a mildly elevated temperature, shallow breathing, and clear discomfort on coughing. A common early postoperative pattern consistent with atelectasis. Incentive spirometry and ambulation. Seen after the six above.

Margin notethe quiet one who stopped answering you is the sick one.

Watch outStrip 2. Rousability is the assessment. A number alone will not tell you this client is in trouble.

TakeawayA client whose airway, ventilation, perfusion, or level of consciousness has changed is seen before any client whose findings are stable, however alarming those findings look. → BOOK 03 · P7 · → BOOK 05 · P9 · → BOOK 07 · P3 · → BOOK 10 · P3