Question

Mary is a 25-year-old college student who presents to the Student Health Center with the following complaints: nausea, vomiting, diarrhea, fever, dry mouth, abdominal pain. She tells the nurse that symptoms started 12 hours ago after she had dinner at the state fair. The physical assessment reveals the following: symmetric abdomen, bowel sounds in all quadrants, dullness with percussion at the liver, and tenderness to palpation in the lower quadrants. Breathing is even and unlabored. Overall color is pale, and extremities are cool to the touch. Vital signs include T: 101°F, HR: 118, RR: 24, BP: 92/68. Prioritize the following patient problems from most important to least important:

Impaired tissue perfusion related to excess fluid losses and increased metabolic need as evidenced by an alteration in heart rate and blood pressure and by cool, pale extremities.

Diarrhea related to a possible infectious cause as evidenced by the patient report of diarrhea.

Risk for electrolyte imbalance related to excess fluid losses.

Acute pain related to biologic processes as evidenced by patient reports pain is 5/10 and tenderness with palpation in lower quadrants.

A) 1, 2, 3, 4
B) 4, 1, 2, 3
C) 2, 1, 4, 3
D) 3, 4, 1, 2

Answer 1

The correct prioritization of Mary's health problems is impaired tissue perfusion, risk for electrolyte imbalance, acute pain, and diarrhea. Tissue perfusion is the most urgent because it poses a serious risk to vital organ functions, followed by the risk of electrolyte imbalance due to severe fluid losses, with acute pain and diarrhea being the least urgent concerns.

Step-by-step explanation:

The scenario presented with Mary, a 25-year-old college student who visited the Student Health Center, involves prioritizing her health problems based on the urgency and seriousness of her symptoms.

Mary exhibits signs of compromised tissue perfusion indicated by altered heart rate and blood pressure, and cool, pale extremities. The priority of her symptoms should be: impaired tissue perfusion, risk for electrolyte imbalance due to fluid losses, acute pain, and diarrhea.

Mary's primary concern is the impairment of tissue perfusion, as evidenced by her vital signs and physical symptoms, which suggests a serious risk to her vital organ functions and requires immediate attention.

Next is the risk for electrolyte imbalance, as severe diarrhea and vomiting can lead to significant dehydration and electrolyte deficits. Acute pain, while important, follows in priority because it is not immediately life-threatening compared to the potential consequences of tissue perfusion and electrolyte imbalances. Lastly, diarrhea is a concern given its role as the potential cause of the above symptoms, but it is less urgent than the immediate physiologic threats.

The correct prioritization of Mary's problems based on the given scenario is: 1) Impaired tissue perfusion, 2) Risk for electrolyte imbalance, 3) Acute pain, and 4) Diarrhea which corresponds to Option A.