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Original Question

John is a new nurse, still in orientation with a preceptor, on the intermediate care unit. The following patients are assigned to John: Room 230—A 48-year-old admitted yesterday evening with an acute myocardial infarction; waiting for an angiogram and needs vital signs taken. Room 231—A 72-year-old patient with chronic congestive heart failure; taking multiple medications for blood pressure and just finished eating. PO intake needs to be documented in the chart. Room 232—A 51-year-old patient who had a coronary artery bypass graft 3 days ago; waiting for IV to be discontinued and needs teaching prior to discharge. Room 233—A 54-year-old patient in the ED with a medical diagnosis of uncontrolled atrial fibrillation; has admitting orders. Needs transported to the floor and admission assessment completed. John is caring for the patients under the supervision of Dana, his preceptor, who is also the day shift charge nurse. He has completed his first assessment and is looking at the medications for his patients. He notes multiple medications ordered for bed 231, new medications ordered for bed 230, and medication teaching needed for bed 232. As he makes the notations to himself, Dana gives him abnormal lab values for the patient in 230, with instructions to notify the provider. The LVN on the floor reminds John of the admit waiting in ED. The nursing assistant points out that the patient in 232 is very impatient; he is waiting for his diet and medication instructions as well as the IV to be discontinued so that he can be discharged. At this point, John becomes frustrated trying to juggle all the demands on his time. 1. Discuss John’s top three priorities and provide a rationale why each one is a priority.

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