A nurse is planning to assess a group of four postoperative clients. Which of the following clients should the nurse assess first?

Rationale:

A. Teaching about a prescribed diet is within the scope of practice of a dietitian or nurse. They can provide instructions on dietary modifications, restrictions, and nutritional counseling, which do not require a social worker’s involvement.

B. Assisting with range-of-motion exercises is part of physical therapy or nursing care. Physical therapists assess and implement mobility and exercise programs to improve function and prevent complications such as pneumonia or deep vein thrombosis.

C. Teaching about home oxygen is typically managed by a nurse or respiratory therapist, who can educate the client and family on safe oxygen use, maintenance of equipment, and monitoring oxygen saturation at home.

D. Arranging financial resources to purchase medications is an appropriate reason to involve a social worker. Social workers help clients identify and access financial assistance programs, insurance benefits, or community resources. They also provide guidance on navigating healthcare systems and overcoming socioeconomic barriers that might affect the client’s adherence to treatment and overall recovery.

Rationale:

1. Client 1: The client has a large laceration (10.2 cm) with radial pulses 2+, tachycardia (HR 114/min), and pain 6/10. While the blood pressure is slightly elevated, the client requires immediate trauma care for bleeding control and pain management, making them a priority for a trauma room.
2. Client 2: This client has bruising and abrasions with stable vital signs and no signs of life-threatening injuries. They can wait for care in a less acute area, so immediate trauma room transfer is not required.
3. Client 3: The client has minor contusion and nausea, is alert and oriented, and vital signs are stable. This is a lower priority patient, so trauma room transfer is not immediately necessary.
4. Client 4: The client has a cervical collar in place, absent lower extremity movement, GCS 14, and borderline hypotension. These findings indicate spinal injury and potential neurogenic shock, making the client high priority for immediate trauma care.
5. Client 5: The client has closed head injury, traumatic amputation, CPR in progress, asystole, fixed pupils, and agonal respirations. This patient is unsalvageable in the current scenario (expectant in mass-casualty triage) and would not occupy a trauma room immediately.
6. Client 6: The client has hypotension (BP 82/54 mm Hg), tachycardia (HR 124/min), abdominal bruising, and is ambulatory but at risk for internal bleeding or shock, requiring immediate trauma room transfer.