A nurse receives a change-of-shift report on four clients. Which client should the nurse assess first?

1. Client who experienced a transient ischemic attack 2 days ago and is due to receive scheduled aspirin.
2. Client who had a subdural hemorrhage 36 hours ago and is requesting a breakfast tray.
3. Client with a bowel resection receiving total parenteral nutrition who had 4,800 mL of urine output during the last shift.
4. Client with a stroke receiving tissue plasminogen activator whose Glasgow Coma Scale changed from 9 to 13.

The nurse should assess the client with a subdural hemorrhage 36 hours ago and is requesting a breakfast tray first. This client's request for a breakfast tray may indicate an improvement in their condition and a return of appetite, which is a positive sign.

However, after a subdural hemorrhage, it is crucial to closely monitor for any signs of increased intracranial pressure or neurological deterioration. Therefore, assessing this client's neurological status and performing a thorough assessment to identify any changes in their condition is a priority.

While all clients require attention, the client with a subdural hemorrhage takes precedence due to the potential for worsening neurological status and the need for timely intervention if any deterioration is identified. The nurse should prioritize assessing the client's level of consciousness, pupillary response, vital signs, and any other neurological indicators.

Once the immediate assessment of the client with a subdural hemorrhage is completed, the nurse can then proceed to assess the other clients based on their acuity and priority of care.

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