Four clients come to the emergency department (ED). Which client should the triage registered nurse (RN) assign as highest priority for definitive diagnosis and treatment?

Question

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Although this elderly client may be unconscious due to intoxication, vomit and decreased level of consciousness place this client at risk for airway obstruction. Treatment of this client is a priority, and measures must be taken to protect the airway (eg, rescue position, head of bed elevation, intubation). (Option A) Bacterial infection is the most common cause of COPD exacerbation. Although clients with COPD usually have cough and sputum, it becomes a concern when the sputum changes in color, consistency, or volume. This client needs antibiotics. The goal pulse oximetry reading for COPD is typically 90%-93% as many clients with COPD rely on their hypoxemic drive to breathe. Therefore, this client is stable and can wait until the unconscious elderly client is treated. (Option B) This child has fifth disease ("slapped-cheek," erythema infectiosum), which is caused by parvovirus B19. Symptoms, in addition to a bright-red facial rash, include fever and general flulike symptoms. It is harmless unless the client has a hemolytic/immunodeficient condition. Pregnant women should avoid contact with infected individuals as the virus can be transmitted to the fetus and cause anemia. Prioritization is determined by acuity, and therefore children do not automatically receive higher priority. However, due to the potential exposure of this child to a pregnant client in the ED, the triage RN should prioritize this client ahead of the one with vaginal infection. (Option C) This client is exhibiting a classic sign of the common Candida vaginitis (yeast) infection. Classic signs and symptoms include itching and irritation in the vulva or vagina, white cheesy vaginal discharge, and low vaginal pH. Although uncomfortable, this client is stable and can safely wait up to 2 hours for treatment. Educational objective: A client with emesis and decreased level of consciousness is a priority due to airway obstruction risk. Sputum changes in a client with COPD signal infection that can cause exacerbation. Although "slapped-cheek" disease in children is usually a harmless viral infection, pregnant women should avoid exposure.

Four Clients Come to the Emergency Department (ED)