The patient is admitted with acute pancreatitis.
He is complaining of severe abdominal pain and nausea.
He has hyperactive bowel sounds and abdominal distention.
His temperature is 103 degrees F and his blood pressure is 86/40 mm Hg. His WBC count is over 20,000/mL. He is jaundiced and the nurse notes a bluish discoloration around the umbilical area.
Which of the following is indicated first in managing this patient?

Choice A rationale

Requesting that family members prepare the body is inappropriate and culturally insensitive in most hospital settings. While some cultures may wish to participate in the washing or dressing of the deceased, the nurse should never assume this or place the burden of postmortem care entirely on grieving relatives. The nurse is responsible for the dignified handling of the body, and the priority is first addressing the emotional needs of the family present.

Choice B rationale

Ensuring the death certificate is completed is a necessary legal and administrative step in postmortem care, but it is not the immediate priority for the nurse at the bedside. The primary focus immediately following the death should be on the psychosocial and emotional support of the family members who are currently experiencing the loss. Administrative tasks can be managed once the family has been initially supported and offered time with their loved one.

Choice C rationale

Calling for emergency assistance to begin resuscitation is inappropriate because the patient is described as terminally ill and has already died. If the patient has a Do Not Resuscitate order or is in the end stages of a terminal disease, performing CPR would be contrary to their wishes and ethically unsound. The nurse's role in this moment is to provide a peaceful environment and support the survivors, rather than initiating futile medical interventions.

Choice D rationale

The priority intervention after a death is to provide compassionate, family-centered care. Offering the family time alone with the deceased allows them to begin the grieving process and say their final goodbyes in a private, respectful environment. This supports the emotional well-being of the survivors and honors the dignity of the patient. Once the family has had this opportunity, the nurse can then proceed with the technical aspects of postmortem body care.

Choice A rationale

In a mass casualty incident, triage focuses on doing the greatest good for the greatest number of people given limited resources. A patient with third degree burns over 85 percent of their body has an extremely low probability of survival, regardless of the level of care. These patients are categorized as Priority 4 or expectant. Resources are diverted to those with survivable injuries. Treatment for expectant patients consists of comfort measures and pain control in a hospice area.

Choice B rationale

Priority 2 or yellow tag patients are those whose injuries are serious but not immediately life threatening. They can wait a short period for treatment. A patient with 85 percent total body surface area third degree burns is in critical condition and does not fit this category. Assigning this patient to the main emergency department for debridement would consume vast amounts of specialized resources and personnel time that are needed to save multiple other salvageable patients.

Choice C rationale

Priority 1 or red tag patients are those with life threatening injuries who have a high chance of survival if treated immediately. While 85 percent burns are life threatening, the chance of survival is nearly zero in a disaster setting. Rushing this patient to the resuscitation room would utilize critical equipment and staff that could be used to save several patients with less severe but still urgent, survivable conditions. Triage ethics prioritize those most likely to live.

Choice D rationale

Priority 3 or green tag patients are the walking wounded with minor injuries who can wait several hours for care or provide self care. Third degree burns covering 85 percent of the body represent a catastrophic injury that is far from minor. Categorizing such a patient as Priority 3 would be a gross underestimation of the severity of the physiological trauma and the immediate need for intensive palliative care to manage extreme pain and distress.