Multiple clients present to the emergency department. Which client should the triage nurse prioritize for diagnostic testing and definitive care?

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The kidney transplant client is likely immunosuppressed by steroids and anti-rejection drugs (eg, cyclosporine, tacrolimus). In general, organ transplant clients will have a blunted response to infection, such as a low-grade fever. This client has systemic symptoms, which may indicate a serious underlying infection. Some of these clients develop fulminant sepsis within a few hours if the antibiotics are delayed. As a whole, management of systemic signs/symptoms takes priority over that of localized signs/symptoms. (Option A) This client likely has cellulitis from IV drug use and will need cultures and antibiotics. However, this should not be prioritized over an immunosuppressed client. (Option C) This elderly client with diverticulosis likely has diverticulitis (infection of the existing diverticula) and will need bowel rest and antibiotics. However, this is not the priority. (Option D) This client with fever and right knee swelling after knee replacement likely has prosthetic joint infection. The joint needs to be tapped, and the client will need antibiotics and potential prosthesis removal. However, this is not immediately life-threatening. It is important to know that such clients (with knee or hip joint replacement) do not take immunosuppressants. Educational objective: Organ transplant (eg, kidney, heart, lung, liver) clients are usually on strong immunosuppressant medications. Infection in these clients can be rapidly progressive and fatal. Even a low-grade fever is a priority due to their blunted response to infection.

Multiple Clients Present to the Emergency Department