The emergency department nurse is triaging clients. Which client is a priority for diagnostic workup and definitive care?

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Overdoses are generally a priority due to the unpredictability of dosing and client response. Specifically, the tricyclic antidepressant amitriptyline (Elavil) is lethal if taken in overdose, especially if consumed with alcohol. It is estimated that 70%-80% of clients with tricyclic antidepressant overdose die before reaching the hospital. Amitriptyline was historically used for depression; it is now used for insomnia and neuropathic pain. Death results from serious cardiac arrhythmias. (Option A) An anterior cruciate ligament injury is common in athletes and results from sudden twisting of the knee. Rapid effusion, pain, and an audible "pop" are classic signs. A pop can also be heard in fractures. Regardless of the specific diagnosis, this is an isolated orthopedic injury. As a rule, a systemic problem (eg, overdose) takes priority over a localized one. (Option B) Glomerulonephritis is inflammation (acute or chronic) of the kidney; manifestations include hematuria that results in urine with a rusty, smoky, or "iced tea" color due to the presence of blood. Because most acute episodes resolve spontaneously, this is not the priority. (Option C) This client has a reasonable potential explanation (scratched cornea) and no history of foreign substance requiring emergent irrigation. Although the client is uncomfortable, the overdose is the priority. Educational objective: Priority is given to clients with overdose, especially those who have taken tricyclic antidepressants as they are at risk for lethal cardiovascular arrhythmias.

The Emergency Department Nurse Is Triaging Clients