[sweetie715]

Thanks to replies to my past entries. I don't know what I would do without this board! Good luck to everyone in their studies.

That being said....I have something I get very confused/frustrated with. For example, I always thought when answering NCLEX questions, you should select (usually) nursing measures that would apply before calling the Dr. Well, what about this situation?

Pt has frothy sputum. What to do FIRST? (I hate these types!)
a)call Dr
b)prop the baby on her side

I would have picked put o nthe side (and THEN call MD) because a)it's a nursing measure and b)it would help so they don't aspirate. But my rationale book says that you'd call MD first because this could be a TEF (which I knew, but I still thought elevating the HOB would help), which is an emergency.

Is it safe to say that if it is an EMERGENCY situation (like acute pulmonary edema, TEF, etc), then call the MD first (BEFORE doing any nursing measures)? Of course in something like a PE, you would apply O2 and that's of course also an emergency situation, so I know there are exceptions.

Thoughts?

[Mytonezucs]

That's a good example of the pointless kinds of questions that are only created to fail you. Most questions along those lines are things you would do anyway maybe seconds apart.

Everything I read tells me to do whatever can be of most help now.

Then you have the ABC thing but they're gonna say "It didn't say the baby was choking".

Has anybody had a class on "what you should do first" or "What's the most important thing" during nursing school?

I didn't think so.

Sorry to sound so bitter but it's very frustrating that we have to be tested unlike we were in school. I guess you can tell I failed.

[dollface99]

Frothy sputum means obstruction and elevation would not make a difference therefore, the Dr. should be called immediately. Think about the situation and place yourself at the seen. The only way frothy sputum will come out of an adult or infant, child mouth is choking. It's not that hard, just relax and think, that's say with a lot of love and experience with myself. Good luck, God will give you the desires of your heart.

[Nuieve]

Well, the second answer is put the baby on the side, not elevate the bed, so it makes the right choice "call dr". Putting baby on the side could probably cause pooling of gastric secretions near the fistula area and make it easier for them to enter trachea through the fistula... with TES you normally put the baby upright. if it's pulmonary edema, you still use upright position with dangling legs to prevent venous return, it's also easier to breathe

putting on the side is useful when the patient is vomiting. you don't put patients with respiratory secretions on the side, instead you encourage them to expectorate the excretions or suction them if they're unable to expectorate

[jill48]

Originally Posted by dollface99

Frothy sputum means obstruction and elevation would not make a difference

But turning her on her side would help in case she clears the obstruction herself. Leaving her lying on her back has no benefits that I can think of. Turning her takes only a second.

[dollface99]

Lets not add anything to the question, thats when things get hairy. The main point call the Dr. because frothy sputum means obstruction.

[jill48]

Originally Posted by dollface99

Lets not add anything to the question, thats when things get hairy. The main point call the Dr. because frothy sputum means obstruction.

You don't have to be rude. I was just trying to tell you why I chose one answer over the other.

[runnerbe]

In My Opinion, "frothy Sputum" You Can Identify If Is Yellow, Green Or Pink. And If That Is The Case-----my Nursing Diagnosis Will Be Or Might Be A Pulmonary Edema, Could Be Infection In The Lungs (PNEUMONIA), Heart Disease. It Means There's A Swelling In Heart Or Fluid. I Dont Know Really Exactly What There's Asking . All I Know In Nclex. Their Asking Very Tricky Question And You Have To Analyze The Problem. In Real Situation, YOU HAVE TO NOTIFY THE DOCTOR AFTER YOUR NURSING ASSESSMENT. My Nursing Intervention, Suctioning B'COZ YOU dont want the patient aspirate the sputum and goes to the lungs, Administer Nebulizer, Ask For Specimen For Culture AND PUT IN HIGH FOWLER POSITION AND ADMINISTER OXYGEN PER DR'S. ORDER. JUST BE CAREFULL WHAT YOU READING. OF WHAT I LEARNED, IF YOU MISREAD THE PROBLEM YOU WILL FAIL. WHAT I DID, I READ IT WORD BY WORD TO MAKE SURE I PICK THE RIGHT ONE. AND IT WORK B'COZ I PASSED MY LPN TEST. GOOD LUCK........NOW IM WORKING ON MY RN NCLEX AND PLEASE INCLUDE ME IN YOUR PRAYER AND I CANN'T WAIT.

[pagandeva2000]

Originally Posted by sweetie715

Thanks to replies to my past entries. I don't know what I would do without this board! Good luck to everyone in their studies.

That being said....I have something I get very confused/frustrated with. For example, I always thought when answering NCLEX questions, you should select (usually) nursing measures that would apply before calling the Dr. Well, what about this situation?

Pt has frothy sputum. What to do FIRST? (I hate these types!)
a)call Dr
b)prop the baby on her side

I would have picked put o nthe side (and THEN call MD) because a)it's a nursing measure and b)it would help so they don't aspirate. But my rationale book says that you'd call MD first because this could be a TEF (which I knew, but I still thought elevating the HOB would help), which is an emergency.

Is it safe to say that if it is an EMERGENCY situation (like acute pulmonary edema, TEF, etc), then call the MD first (BEFORE doing any nursing measures)? Of course in something like a PE, you would apply O2 and that's of course also an emergency situation, so I know there are exceptions.

Thoughts?

I would have placed the child on the side and then called the physician because it may take time to reach him/her and something has to be done in the meantime to open the airway. I do agree with others, that these sort of questions are really sort of pointless and have always wondered why NCLEX books have them. I have found that many of them are wrong, anyway and it usually does require that there is a first immediate intervention that a nurse should do. My Kaplan book stated that in most cases, NCLEX wants to know what the NURSE will do first and that most answers that require contacting a physician should not be considered as a first choice.

You should feel free to post as many times as you want...these things make us think and support each other!

[dollface99]

Sorry, if I came across as being rude but, thats not the case. We are all just trying to help a soon to be RN answer the question by posting different views. Sorry again and have a nice day jill48. God bless:biere: