Collaborating with HCP: Prioritize Orders – COPD Nursing Care in ER

by Rhonda Lawes, PhD, RN

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    00:01 Okay, so now what do I do? I just got this whole sheet of orders.

    00:05 Well, it's a common thing that happens to all nurses so you have to play the role of how do I figure out by looking at the health care provider orders what are the most important.

    00:15 So what do you think are the top priorities? Pause for just a minute, look back at the orders, which orders are the most important to keep Mrs. Taylor safe that you should facilitate or complete first.

    00:29 Okay, so I want you to pause the video and think about COPD, think about your assessment, walk yourself through what you just did with situation, background, assessment, and what you think should be done then you prioritize what you think are the first orders, the highest priorities to keep Mrs. Taylor safe because you can't do everything immediately so you have to look at what you do first.

    00:54 Pause the video, make your selection, and then we'll come back and talk through it.

    01:02 Okay, let's see how you did.

    01:05 Let's see what we identify as priorities and what you think were the priorities.

    01:09 COPD, respiratory distress, so these are the top things that you're gonna do quickly.

    01:14 You're gonna get those blood gases drawn stat, right? And while you're there, you probably gonna have to just draw the other blood for the other lab work just because you have those extra samples.

    01:24 But we wanna titrate that oxygen so draw those blood gases first.

    01:29 Most ER nurses had been certified to draw arterial blood gases so you could get that done right away.

    01:35 They also have machines right on their units where they can run that test.

    01:39 It doesn't have to go to lab.

    01:41 So you're gonna draw that ABG stat, you're gonna note the time that you drew it, and the oxygen that the patient's on when you drew it, and you're gonna realize keeping track of when you have to do that in 1 hour and 4 hours.

    01:54 Now, that oxygen is already not meeting the target so I would be bumping up that, draw those ABGs, turn up that IV by -- or the oxygen by titrating it according to the health care provider's orders.

    02:08 Now, you probably already put a pulse ox monitor on the patient but you're gonna make sure that's on and it's got a good, strong pattern for us.

    02:17 Now, the breathing treatment is gonna interact with her lungs directly.

    02:21 Hopefully that's gonna help us bronchodilate and give her a little bit of relief.

    02:25 So since ABC is my top priority, I'm gonna go for airway first.

    02:31 ABGs, titrating oxygen, monitoring her pulse ox, and getting that breathing treatment to her.

    02:37 Now likely, in an ER, you have a respiratory therapist on unit so you'll facilitate that.

    02:44 You may or many not be the one who actually gives the breathing treatment. You can.

    02:47 That's within our scope of practice but also if you have a respiratory therapist available on the unit, you may facilitate them getting that in quickly for Mrs. Taylor.

    02:57 Okay, so we're working through priorities. First, draw those ABGs stat.

    03:03 Now, make sure you note the supplemental oxygen on the lab request.

    03:06 Now, if you're the one that's doing the ABGs, you wanna make sure you enter that information into the machine.

    03:12 So draw the ABGs, note the time, and you also want to note the amount of oxygen the patient was on when you drew the ABGs.

    03:19 Now you gonna titrate oxygen according to the orders, have the Venturi mask equipment ready nearby in case it's needed which it will always be located on the unit.

    03:30 You wanna keep watching that pulse ox closely and you wanna give it albuterol nebulized breathing treatment stat.

    03:36 Okay, that just summarized what our priorities were.

    03:39 Now remember, we're doing this in slow motion.

    03:43 Think if you were watching an American football game when they play the video back in slow motion, that's what we're doing because you're just learning.

    03:52 All of this would have happened in a snap, in a blink of the eye in a real ER unit.

    03:57 But we're stopping, slowing down the speed so that you can start to learn to prioritize and process how you'll perform as a nurse.

    About the Lecture

    The lecture Collaborating with HCP: Prioritize Orders – COPD Nursing Care in ER by Rhonda Lawes, PhD, RN is from the course Respiratory Case Study: Nursing Care of COPD Patient.

    Included Quiz Questions

    1. Get STAT arterial blood gases (ABGs).
    2. Titrate oxygen every 15 minutes to maintain a saturation of 90–93%.
    3. Monitor oxygen saturation continuously.
    4. Administer albuterol breathing treatment as ordered.
    5. Record accurate intake and output.
    1. To keep the client safe
    2. To assist the health care provider adequately
    3. To follow the quality assurance processes correctly
    4. To make sure the client is billed correctly for services

    Author of lecture Collaborating with HCP: Prioritize Orders – COPD Nursing Care in ER

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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