RESPIRATORY PRIORITIZATION AND COMMON SENSE

[Music] hello climic review family I think you're going to like the video today we're going to be doing respiratory prioritization so we're going to be looking at best and first questions a lot of first questions I haven't done a lot of those before and I'm also going to be using common sense in this as well okay first let me say thank you to all of our channel members and if you are interested in paying me for something you can go to climic review.com and sign up for my nextg small group tutoring you do have to pay for that and you can also at the same time or or instead of you can sign up for Mark kimik small group tutoring or you can sign up for the climic online OnDemand review which is the best uh enclex review in the universe in my opinion so let's go ahead and get started with our prioritization respiratory prioritization questions the nurse is caring for a client who has had a lobectomy and placement of a chest tube eight hours ago when performing an initial assessment which of this requires immediate followup 200 Ms red drainage from the chest tube over two hours client sleepy but able to be aroused 3 cmers area of red drainage on the incisional dressing report of pain at the chest tube insertion site so read the question read the answers again read the question again the nurse is caring for a client who has had a lobectomy and placement of a chest tube eight hours ago when performing an initial assessment which of these requires immediate followup so it's the initial assessment that's a key word y'all this is the initial assessment and immediate followup those are the key words so iMed anything that it says which would require immediate followup or which would you be most concerned about or which would you call the doctor about all those mean the same thing whenever you see that word requires immediate followup you say which of these is unexpected okay which of these is unexpected that's why the initial assessment is key because which is unexpected at the initial assessment after someone who just had part of their lung removed and a chest tube placed okay so you say to yourself 200 Ms of red drainage from the chest tube over two hours is that expected or unexpected well they did just have surgery so you would expect there to be some drainage but I don't know that I would re expect 200 Ms of red drainage over two hours I might exp expect Ser sanguinous drainage they did have surgery so there's going to be some blood in there so I would expect some sir sanguinous maybe even some more pink you know that's zero sanguinous but 200 Ms of red drainage I'm concerned about that because this is my initial assessment they just had surgery so I'm wondering if they're bleeding somewhere and the key word in the qu in that answer is red if it said serosanguinous I would not be as concerned about it B client sleepy but able to be aroused well they just had surgery this is my initial assessment so that's expected 3 cmers area of ra Red drainage on the incisional dressing so 3 cm of red drainage well that's not unexpected they just had surgery they may have leaked out a little bit some of the uh blood might have leaped out onto the posttop dressing so I do want to keep my eye on it make sure it doesn't get more there's not more but immediate followup is not what's required it's requires some sustained followup but not immediate follow-up report of pain at the chest tube insertion site well that's expected do I want to do something about it yes but it doesn't require immediate followup you got to understand the words in these questions immediate followup means this is unexpected that's what that word means so the only one here that's unexpected because I expect pain I expect to be sleepy I expect there to be some drainage on the posttop uh dressing but I don't expect there to be 200 Ms of red drainage from the chest tube over two over two hours that's a lot it's red it could indicate bleeding they just had surgery and this is my initial assessment so a is the correct answer and this is a prioritization question because it's asking you what is unexpected what is the one that is your highest priority what's the immediate followup which one requires you to call the doctor okay question two a client has just been admitted to the ICU after having a left lower lobectomy via video assisted thoros scopic surgery which of these prescriptions will the nurse Implement first tirate oxygen flow rate to keep O2 sat at or greater than 93% administer two grams of seasol and Ivy now give morphine sulfate 4 to six milligrams IV for pain or trans one transfuse one unit of pack red blood cells over two hours all right a client has just been admitted to the ICU after having a l lower lobectomy via video assisted thoros scopic surgery which of these prescriptions will the nurse Implement first so here they give you a patient and then they ask you which prescription or which it could say which order will you implement first whenever they ask you this question they say here's what's going on with a patient which order or prescription do you implement first you always prioritize according to maslo and for climic reviews we talk modified maslo so highest priority are objective physiological problems second is safety and third is comfort so we have to identify according to the order what does it address so a addresses hypoxia hypoxia titrate the oxygen to greater than 93% that addresses hypoxia hypoxia is an objective physiological problem two grams of seasol and IV now that addresses a potential infection there's no actual infection there shouldn't be there's no actual infection it's a potent to prevent potential infection and so at this point I want to address actual problems not potential problems first so I'm going to cross off B for now give morphine sulfate 4 to six milligrams IV for pain well pain is Comfort it's subjective right anything subjective is comfort so I already have a physiological objective finding an A so I'm going to cross off C for now transfuse one unit of pack blood cells over two hours so that may be let's say they're anemic it doesn't tell us they're anemic but let's say they are that's why it's given it's given for anemia so we have two objective problems we have hypoxemia or hypoxia in a and we have anemia and D even though they didn't tell us those were their problems that's why you do those two interventions so would it be a higher priority to address hypoxia or anemia and in this case we're going to go with the ABCs and we're going to say Airway breathing and then circulation so we're going to go with Airway breathing first which is a circulation would be D making sure they're profusing with enough red blood cells that would be D so we're going to go with a as our top priority I do have prioritization videos um that are they are labeled as prioritization videos where I teach these two strategies okay I teach both of the strategies the one I did in question one and the one I did in question two I teach the strategies themselves three the change of shift report has just been completed on the med surge unit which client will the oncoming nurse plan to assess first so this is not what are you most concerned about this is not which order will you implement first this is which patient you will see first so when you have four patients four patients you see the unstable Patient First so let's read through this and see who's unstable client with COPD who is ready for discharge but is unable to afford prescribed medications well if they're ready for discharge y'all they are stable otherwise they wouldn't be going home so we're going to cross off a for now we can come back to it if none of the other patients are unstable but right now we're going to cross it off because they're clearly stable client with cystic fibrosis who has an elevated temperature and a respiratory rate of 38 breasts per minute well they're unstable that's a very high respiratory rate the temp is up I'm concerned if they have some immune issues going on or an infection in addition to cystic fibrosis I'm concerned about that and don't say well 38 breasts per minute is expected with cystic fibrosis it is not expected with cystic fibrosis that is an unexpected finding I don't care their diagnosis is cystic fibrosis I don't expect their respiratory rate to be 38 so B is unstable so I'm keeping there on my list a hospice client with endstage pulmonary fibrosis and an oxygen saturation of 89% so I would say they were unstable except they're hospice and hospice patients are uh they can be unstable and we don't do anything about it that's why they're in hospice so even though C is unstable because they're hospice I'm not going to prioritize them D client with lung cancer who needs an IV antibiotic administered before going to surgery so that's I mean we need to get that going but it they're not unstable and we always see the unstable patient first so don't say to yourself well I could just give them their antibiotic really quick and then they'll go to surgery and then I'll go see B no that's not how you answer these questions you see the unstable Patient First so B is unstable and that's who we're going to see first all right question four a client with acute exacerbation of asthma has been admitted to the medical surgical unit for treatment the client is reporting increased shortness of breath with inspiratory and exper expiratory wheezes when planning care for this client which medication will the nurse administer first so this isn't I mean it's a first question so it is a prioritization question but this one is one you just have to know you either know it or you don't beta 2 agonists uh they're the ones that open up the Airways so short acting and long acting beta 2 Agonist they end in e rol L AOL Sal meterol and albuterol are the two beta 2 Agonist that open up the Airways iopi is not a rescue medication and fluticasone is a steroid usone drugs and in that's a steroid it's not a rescue medication so we're going to choose between C and D so cell meterol they end an AAL it's a beta 2 acting uh beta 2 Agonist so cell meterol is the long acting one albuterol is the short acting one it doesn't matter that it has a two after the end of it don't let that throw you off um the correct answer is albuterol yall you got to know that that's very fundamental nursing knowledge um albuterol is always the rescue medication and this person needs rescue right it's an acute exacerbation you know it it's rescue medication because it's an acute exacerbation so we need to do the rescue Med all right five when caring for the client with chronic bronchitis which of these interventions will assist the client in mobilizing secretions which of these interventions will assist the client in mobilizing secretions Elevate the head of the bed 45 degrees consume at least two liters of fluid daily avoid triggers which cause coughing or assume the tripod position okay let's read it again when caring for the client with chronic bronchitis so that's the problem which of these interventions will help assist the client in mobilizing secretion so it doesn't sound like a prioritization question but it is it's the it's a best nursing action question best nursing action questions are prioritization so which of these will it doesn't say best assist the client but that's what it means is wh which will best assist the client mobilizing secretions so what we have to do is relate each one back to mobilizing secretions don't relate it back to just general respiratory which one is helpful in mobilizing so Elevate the head of the bed 45 de will help in mobilizing secretions well I suppose would sitting up help mobilize secretions I mean I don't know that's not in my experience that's not specifically helpful for mobilizing secretions it helps to expand your lungs more but it's not specific to mobilizing secretions so I'm going to cross off a for now I'll come back to it if none of the other answers make sense consume at least two liters of fluid daily well if I can thin out the secretions I know it helps in coughing that up or mobilizing them so B is a good option I like B and don't be afraid of two liters y'all the recommended fluid intake for a person on a on a daily basis is two to three liters daily so don't be afraid of two liters don't even be afraid of three liters unless they're fluid volume overloaded okay if they're fluid volume overloaded we're not going to go up to three liters but for a healthy adult with function not healthy but an adult with functioning kidneys we don't need to be afraid of two to three liters so I like B avoid triggers which cause coughing well that doesn't help mobilize secretions if I'm not coughing I got to cough them up so I don't like C assume the tripod position so the tripod position is leaning forward will that help mobilize secretions I mean it might positioning that positioning I mean it's better probably than other ways you can sit but it's not a specific intervention for mobilizing secretion so the only one that makes any sense is to consume two liters of fluid a day and the only reason you wouldn't pick that is because you'd be scared of two liters so you have to don't be scared of that remember two to three liters it's the recommended fluid intake for an adult with functioning kidneys okay so don't be afraid of that amount of fluids all right question six the client says I hate this stupid COPD what is the best response by the nurse all right so this is a question that really is a psych question wrapped in a med surge setting so he's saying I hate something or someone's expressing anxiety I'm scared I hate this I don't know what to do about this these are all Psych statements and so whenever you the patient makes a statement and says what's your best response what it's really asking is what's most therapeutic now can only you can only say that in a psych question so don't say most ther itic if it's a straight up Med surge question but this is a site question wrapped in a med surge setting so what we're really looking for is most therapeutic and he's saying I hate this so what is a response to that stopping smoking will help your lungs heal well the that's not bad but stop it doesn't really address his concern right he hates COPD and so we're saying well if you stop smoking you're going to get over COPD well it will help his lungs heal to some degree but it doesn't reverse COPD because C the C in COPD stands for chronic so if I say stopping smoking will help your lungs heal it may help their lungs heal but it's not going to reverse the COPD so it's a very misleading statement it's not absolutely false but it's misleading so a is misleading I don't want to say something misleading you sound fed up with managing your illness is that therapeutic well it's reflecting back to them what you hear them saying so they say I hate COPD and you go okay what does that really mean that's kind of reflecting back to them you sound fed up with managing your illness that is a therapeutic interaction right there's therapeutic statement so I'm going to keep be on the list does anyone in your family have COPD I don't know how that helps him and it's a closed ended question which isn't therapeutic so I'm crossing off seat most clients get used to it after a few months well that's a false statement I can't imagine that's true and even if it was true it's not helping him out any so the only one that's therapeutic here is to say you sound f up with managing your illness reflection clarification that's appropriate to do all right question seven the nurse is assessing a client admitted with status asthmaticus so status asthmaticus is asthma attack that's not getting better even though You' kind of treat it the nurse finds a sudden absence of wheezing in the lung fields and sets which of these as the priority action education to prevent future exacerbations administration of a Bronco dilator measures to reduce anxiety or activation of the rapid response team to secure an airway so status asthmaticus is as an asthma attack that's not getting better with treatment so I'm thinking the fact that it's called status asticus tells me that it's been going on a while and my guess although it doesn't say this my guess is they already took an inhaler at home or they've already tried an inhaler because if if they haven't tried an inhaler they can't call it status asthmaticus okay otherwise they just go well they're having an asthma attack but if they're treating it and it doesn't get better at status asthmaticus so all of a sudden they have an absence of wheezing so they have asthma attack that's not getting better despite treatment and then all of a sudden they have the wheezing they had is gone that is actually a sign that the that there Airways have closed off it didn't say they now have lung sounds that's not what it said doesn't say they now have lung sounds it says they have an absence of wheezing so what that means is you're not hearing anything is what it means you're hearing nothing okay so if you're hearing nothing if their Airway has closed so much you have to activate the rapid response team so the key word in this question is the term status abicus and absence of Wheezy those two words combined status asticus and absence of wheezing you combine those words together it tells you they're not getting any air into their lungs and you need to secure the airway all right question eight when caring for the client returning from thorocotomy and placement of a chest tube the client reports severe pain what does the nurse do first okay so all right so they've got a chest tube and they're saying I just had this procedure and now have a chest tube and I'm having really severe pain oh man this really killing me okay all right what am I going to do assess location and quality of the pain call the rapid response team check the patency of the chest tubes or call the healthc care provider so what do I do first okay first all right so I like a I'm not ready to do B first because they're having severe pain but I don't have enough information to call Rapid resp response okay I don't know anything except they're having severe pain so I I just don't know enough so I like a I'm not ready to do B yet I like C and D to me is not first this is a first question so I'm calling off I'm I'm crossing off B and D um as not first pretty confident those are not first so the question is do I want to assess the location quality of pain before I check the patency of the chest tubes or do I want to check the patency of the chest tubes before I assess location quality of pain so they're both sort of assessment options but I would rather know where the location quality of pain is because if it's not at the chest tube site maybe it's somewhere else right I don't even know where it's at so why would I check the patency of the chest tubes until I know at least know where the pain is and when it's occurring is it occurring with the deep breath is it occurring all the time is it at the chest tube site is it at the different incision site like where is this right so I have to do a first otherwise I don't really know what to do after that I've had a lot of people say well you always assess first y'all you don't always assess first if you have enough data to do something then you do something but if you don't have enough data to do something then yes you have to assess first and here we don't have enough data to do anything so we yes we do have to assess first okay question nine the nurse is evaluating and assess ing a patient with a diagnosis of chronic empyema the patient is receiving oxygen at 5 liters per minute by nasal canula which finding concerns the nurse immediately fine by basil or crackles respiratory rate of eight breasts per minute patient sitting up and leaning over the night stand or a large barrel chest all right the nurse is evaluating and assessing a patient with diagnosis of chronic empyema so they've got empyema is chronic they're getting oxygen which finally concerns the nurse immediately so this is this is the same question question where it says which would it require immediate followup when you see the the word immediately whether it says you see a UAP doing something which would require you to intervene immediately when you see the word immediately in the question that tells you there's something really wrong here really unexpected it's not the right thing okay so this is a patient with empyema who's got oxygen going to five liters a minute so which am I most concerned about well I'm concerned about the unexpected fin so what I expect someone with chronic emphy to have fine by basil or crackles maybe I mean maybe I yeah I guess so I I I I'm more used to hearing wheezes I'm not crazy about crackles I'm going to keep that on the list in case something else is not more unexpected respiratory rate of eight breasts per minute well that's super unexpected I don't expect some with chronic empyema to have a respiratory rate of eight breasts per minute that's definitely more unexpected than a a for sure so I'm crossing off a I'm going to keep B the patient sitting up and leaning over the nightstand well that's that's expected with chronic empyema that that's tripod position they're sitting in tripod position that's that's something we teach them we say well if you're feeling short of breath sit in tripod position so okay so C is expected d a large barrel chest well they have chronic empyema so that's expected so the only one that's not expected is a respiratory rate of eight breaths per minute all right 10 patient with chronic obstructive pulmonary disease COPD tells the UAP that he did not get his annual flu shot this year and has not had a pneumonia vaccination which Vital sign change will be most important for the nurse to instruct the UAP to report okay COPD no flu shot no pneumonia vaccine okay what do we want to tell the U they're taking their Vital Signs and we say hey if you see this tell me blood pressure 152 over 84 respitory rate of 27 heart rate of 92 or oral temp of 101.2 okay so I always want to have them report unexpected findings so is a blood pressure of 152 over 84 unexpected well it doesn't say he has hypertension but it's not that high okay that's like stage one hypertension so I'm not that I'm not that concerned about that right off the bat now if nothing else is is more weird than maybe that one but a stage one hypertension I usually don't say you got to report it to me right away respiratory rate of 27 that y'all that's pretty high I don't like a respiratory rate of 27 so I'm going to keep that on my list that's tell me if the respiratory weight gets that high heart rate of 92 that's within normal limit so I'm crossing that off oral temp of 101.2 okay that's abnormal so unexpected so B and D to me are both well a b and d are all not expected but a is is not that concerning so I'm crossing a off so B and D so am I more concerned in a patient with COPD who did not get their flu and pneumonia vaccine am I more concerned about a respiratory rate of 27 or an oral temp of 101.2 So based on the data that they gave me I don't think this is an easy question y'all because I am concerned about a respitory rate of 27 but based on the data that they gave me specifically which was about not getting the flu and the pneumonia vaccine I'm going to have to go with the oral Tempo 101.2 because that indicates to me that they could be having the flu or could be turning into pneumonia okay all right well I hope that helped you um you're going to see probably 30% of your enlex is going to be prioritization questions I hope it helped you um the strategies I taught you here can be used for other questions they I'm any prioritization question over over any topic these are all strategies that can be used no matter the topic if it's a prioritization question you can use these strategies so I hope you have a great rest of your day thanks bye

Channel: Klimek Reviews: Official Home of Klimek Reviews

Views: 49,606

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Id: uusLLzxpFEs

Length: 24min 56sec (1496 seconds)

Published: Tue Oct 24 2023