Question

Prioritization Activity

The nurse has received reports on two patients:

Patient 1: Mr.  Jones is a 38-year-old male admitted for evaluation of fever, fatigue, and cough. Mr. Jones was diagnosed with HIV+ a year ago and has been managed on HARRT.

Vital signs are:

Temp    100.5

Pulse    95

Resp     24

BP        100/60

Significant diagnostic findings: CD4+ = 300

Chest x-ray unremarkable Rash noted across chest

Patient 2: Mr. Smith is a 55-year-old male presently complaining

of nausea, vomiting, diarrhea, fever, and extreme fatigue. Pt states he has been feeling bad for a while, but his symptoms have begun to get worse. Past medical history of hypertension and DM type II.

Vital signs are:

Temp    101.5

Pulse    102

Resp     20

BP        95/55

Significant diagnostic finding: CD4+ count 150

Chest x-ray suspicious for pneumonia New wound on left thigh

The nurse should see which patient first? Explain your rationale completely.

Answer 1

The nurse should see first Mr. Smith who is presented with nausea, vomiting, diarrhea, fever and extreme fatigue. He has history of diabetes mellitus, hypertension. His vital signs are temperature is 101. 5, pulse is 102 beats/minutes, respiration is 20 breathes/minutes, blood pressure is 95/55 mm of Hg, he has significant findings CD4 count is 150. His chest X-ray showed suspicious for pneumonia and he has new wound on thigh

Comparison

Sno	variables	Mr. Jones	Mr. smith
1.	Age	38 years	55 years
2.	Symptoms	Fever, fatigue, cough	nausea, vomiting, diarrhea, fever and extreme fatigue
3.	Diagnosis	HIV	Suspected pneumonia
4.	Past history	No past history	Hypertension, diabetes mellitus
9.	Vital signs	Temperature: 100. 5 F Pulse : 95 beats/ minutes Respiration : 24 breathes /minutes Blood pressure: 100/60 beats/minutes	Temperature: 101. 5 F Pulse : 102 beats/ minutes Respiration : 20 breathes /minutes Blood pressure: 95/55 beats/minutes
6.	CD4	CD4 300 cells	CD4 150 cells
7	Chest x-ray	Unremarkable rash across the chest	Suspected pneumonia and has wound on thigh

Reason:

Mr. Smith age is 60 year old. Their immune system is lower and they prone to get infection and he has presented with many symptoms such as nausea, vomiting, fever, and extreme fatigue and his symptoms become worse and states feeling unwell. He prone to hypovolemic shock when his pressure below the 95/55. He has higher temperature and pulse than Mr. Jones with HIV. His chest X-ray showed suspected pneumonia and has new wound on thigh. Most importantly, he has low CD4 cells count than Mr. Jones. Low CD4 cells indicate regarding the patient about his immune status. Additionally He has LOW CD4 cells as a result of autoimmune disease, infections, immunosuppressive therapy, lymphoma, and idiopathic conditions. He is prone to opportunistic infection due to decreased CD4 cells count. He may have been suffering from Human immune deficiency infection. Because he shows symptoms such as fever, vomiting, diarrhea, extreme fatigue, pneumonia that mimic symptoms of human immunodeficiency infection.

Mr. jones has been diagnosed to have HIV and has been placed on HARRT. He has higherCD4 cells than MR. Smith. He shows mild symptoms than Mr. Smith