This is your first week as an RN in a small rural hospital. You work the night shift on a medical-surgical unit. Tonight your only aide and a nurse have called in sick, which makes the unit short-staffed. You have notified the night supervisor that you need help, and send an aide from another floor to assist you. She tells you she can get someone on the floor to help you in about an hour, and instructs you to take care of the priority cases until that time.

You have six relatively uncomplicated patients, and you need to check their vital signs and give medications. You have four other patients about whom you are concerned:

1. Jason Brown, a 64-year old patient with a tracheostomy, has gurgling sounds coming from his tracheostomy and a frequent, nonproductive cough. His oxygen saturation level via pulse oximetry is 88%. You have orders to suction his tracheostomy prn.
2. Gwen Galloway had been receiving chemotherapy and has now come back to the hospital with gastroenteritis. When you arrive on your shift, she is experiencing bouts of nausea and vomiting.
3. Claudia Tran, an 84-year old patient from a nursing home, is post-CVA. She has a stage 3 pressure ulcer on her coccyx and stage 1 ulcer on her left hip. She needs to be turned every 15 minutes because of rapidly developing erythema on bony prominences. She is confused and has fallen the past 2 nights when left unattended, even when restrained. Her family is visiting her now but plans to leave in 30 minutes.
4. James White has COPD. The aide reports that the blood pressure from the automatic cuff is 168/100 mmHg; his baseline is usually 130/70 mmHg. The aide also reports that he has a severe headache but no other complaints.

Identify the order in which you would provide care to these patients.

Explain your rationale as well as your interventions.