Now it’s your turn to practice using the 10 Critical Steps of a Triage Call with a new case study. This lesson introduces you to Maria and her 80-year-old father, Juan, who is acting groggy and less responsive than normal.

Step 1

Speaking confidently, slowly, and clearly, you verify that you’re talking with Maria, the daughter of the patient. She tells you that her father is ill, but stable enough to collect more information about his condition.

Step 2

You verify his name is Juan, and that he has not seen his primary care provider, Dr. Gonzalez, in about a year.

Step 3

Because of Juan’s advanced age, you recognize the importance of asking more questions and considering any chronic illnesses when determining the safest level of care.

What open-ended questions would you ask?

Maria tells you Juan was diagnosed with Type 2 Diabetes about ten years ago; that he takes medication for high blood pressure; that he was widowed five years ago; and that he lives in a one-story house. She says he’s normally able to do his ADLs without assistance, seldom goes to the doctor, and has Medicare with no supplemental insurance.

Step 4

You let the patient speak by asking, “Tell me what prompted you to call the nurse triage this afternoon?”

Maria says she found Juan sitting in his favorite recliner with his eyes closed, that he’s groggy and less responsive when she prompts him.

Step 5

You ask if Juan is stable to complete the assessment. He makes eye contact but says he is very tired. Maria explains that Juan needed to brace against a wall earlier when going to the bathroom because he felt lightheaded.

Maria is able to take her father’s current vitals: temperature 101 degrees; blood pressure 90/40; heartrate 107; respirations at 10/minute; and 98 percent oxygen saturation in room air.

Blood sugar is greater than 600.

Step 6

Which protocol would you choose? Diabetes is the likely option, and you start thinking about the worst-case scenario. A glucose reading that high could be indicative of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). By asking Maria some additional questions about Juan’s symptoms, it sounds like HHS is more likely.

Step 7

Because of Juan’s current condition, and the high mortality of HHS (19 percent), you determine that Maria needs to get Juan to an emergency room.

Step 8

You tell Maria not to delay care, and advise her to bring her father’s medications with her when she takes him to the closest ER.

Step 9

You let Maria know about the symptoms she should watch for in case she needs to pull over and call 911 before reaching the ER, including if Juan loses consciousness or stops breathing. If that happens, you advise her to administer CPR while she waits for help to arrive.

Step 10

You ask Maria, “Are you able and willing to take your father to the nearest emergency room right now?” She agrees and takes him.

Later that evening, Maria calls back to let you know that they arrived at the ER safely, that her father was diagnosed with a UTI, and that he was admitted to the ICU with the expectation of a full recovery.