NUR 4153-Deliverable 7-The Dynamic Process of Clinical Judgement Rank the three scenarios provided in order of priority related to which client you will assess first, second, and third.

The first patient is JR, a 55- 55-year-old male admitted 8 hours prior for a 24-hour hold to evaluate for possible myocardial infarction. Serial Troponins within normal range and 12 lead ECG indicated evidence of prior right anterior wall myocardial damage. The second patient is EH, a 40-year-old female admitted within the past hour with acute onset severe right upper quadrant pain and vomiting for 36 hours. Waiting on labs, ECG monitoring showing occasional premature ventricular contracts (PVCs). The third patient is BW, a 21-year-old male athlete admitted yesterday with a fever of 103 and a diagnosis of influenza. He rested well overnight. Morning chest x-ray revealed mild infiltrates in the left lower lobe.

I will assess the EH, the 40-year-old female first, and BW, the 21-year-old male second. I will assess JR, the 55- year-old male, after assessing the first two patients.

Defend your selection for the three ranked scenarios.

 EH is in severe pain, and she has been vomiting for 36 hours, which is a high risk for electrolyte imbalance and severe dehydration. She is also showing symptoms of possible gallbladder inflammation/Acute Cholecystitis, which is an emergency and requires surgery. She needs immediate attention for pain management, electrolyte replacement, cardiac monitoring, and further tests to determine the root cause of her symptoms.

I will assess the BW, the 21-year-old male second. He is diagnosed with influenza and running a fever, and a chest x-ray revealed mild infiltrates in the left lower lobe. Infiltrates in the lung indicate the possibility of lower respiratory tract illness and secondary infection that can lead to serious complications and mortality (Schub et al., 2018). A further chest x-ray should be ordered to rule out pneumonia. He needs antipyretics to reduce the fever. He also may need to be started on antibiotics and antivirals if indicated.

I will assess JR, the 55- 55-year-old male, last because he is the most stable patient of all three. JR’s troponin levels are normal. Usually, an elevated troponin level would cause concern as raised troponin levels indicate myocardial infarction. Still, since his levels are normal, it is not a serious issue (American Board of Emergency Medicine, 2021). The 12 lead ECG indicated evidence of prior right anterior wall myocardial damage; however, that is not a priority concern at this time.