Question

physician’s orders

• apply oxygen by nasal cannula; titrate to keep spo₂ ≥ 95%.
• chewable aspirin 325 mg po.
• morphine 2 mg iv every 5–15 minutes prn chest pain.
• nitroglycerin 0.4 mg sublingual every 5 minutes prn chest pain. may repeat for a total of 3 doses. hold for systolic bp < 90 mmhg.
• heparin 50 mg/kg iv bolus, then 12 units/kg/hour.
• atorvastatin 80 mg po daily.
• maintain continuous ecg monitoring.

the nurse receives orders from the physician.
which 4 orders does the nurse prioritize?
☑ 1. oxygen by nasal cannula to keep spo₂ > 95%.
□ 2. morphine 2 mg iv every 5–15 minutes prn chest pain.
□ 3. heparin 50 mg/kg iv bolus, then 12 units/kg/hour.
□ 4. atorvastatin 80 mg po.
□ 5. nitroglycerin 0.4 mg sublingual every 5 minutes prn ch
□ 6. chewable aspirin 325 mg po.
□ 7. continuous cardiac monitoring.

Explanation:

To determine the top 4 prioritized orders for a patient (likely with acute coronary syndrome), we prioritize interventions addressing immediate life - threatening issues and core acute coronary syndrome management:

1. Oxygen (1): Maintaining adequate oxygenation ($\text{SpO}_2\geq95\%$) is vital for tissue perfusion, especially in cardiac events.
2. Aspirin (6): Chewable aspirin (325 mg PO) is given immediately to inhibit platelet aggregation, a key step in preventing further thrombus formation in acute coronary syndrome.
3. Nitroglycerin (5): Sublingual nitroglycerin (0.4 mg every 5 minutes PRN chest pain, up to 3 doses) relieves chest pain by vasodilation, improving coronary blood flow and reducing preload/afterload.
4. Heparin (3): Heparin (50 mg/kg IV bolus then 12 units/kg/hour) is an anticoagulant, crucial for preventing thrombus expansion in acute coronary syndrome.

Morphine (2) is for pain but is secondary to oxygen, aspirin, nitroglycerin, and heparin. Atorvastatin (4) is a statin for long - term lipid management, not immediate. Continuous cardiac monitoring (7) is important but the first four address more immediate physiological needs.

Answer:

1. Oxygen by nasal cannula to keep $\text{SpO}_2 > 95\%$.
2. Chewable aspirin 325 mg PO.
3. Nitroglycerin 0.4 mg sublingual every 5 minutes PRN chest pain.
4. Heparin 50 mg/kg IV bolus, then 12 units/kg/hour.