[MomenTs]

It's not from any book so am not citing it. But here's a scenario someone had posted on this site a while back.

The nurse is caring for a patient going to have a colonoscopy. What is the MOST important thing for the nurse to assess?
a. respiratory
b. fluid and electrolytes
c. comfort level
d. nutritional status

[MomenTs]

a) respiratory as Airway comes before everything else.

But there's something at the back of my head telling me b) fluid and electrolytes. which one do u think and why?

[otan11]

when it comes to abc's it should be letter a.respiratory...

i agree with "moments" cause we all know that in preparing a client who will undergo colonoscopy procedure she/he should be on liquid diet few days before the test no solid foods,bowel prep etc...thats why after the test the doctor usually orders DAT(Diet as tolerated) if is not contraindicated....(based on my experienced only).....

[MomenTs]

Thnx Otan11. What do you mean by DAT? What is its full form? Thank you again.

[angle85]

it is elusive qustion, but I think
a. respiratory
as base line data because the pt will recieve sedative.

[EzBSN]

for me it wld be respiratory.... remembering ABC's...

[chris_at_lucas_RN]

Originally Posted by MomenTs

Thnx Otan11. What do you mean by DAT? What is its full form? Thank you again.

"Diet As Tolerated"

[Leda]

Here is another way to look at the question and answers. I am aware that there will be disagreement with my posting but it is important to remember that, airway is only the best answer when it fits the specific information in the questions. Because you only have limited information "Patient is going to have a colonoscopy" then you must select the answer that relates to all patients undergoing a colonoscopy, within the time frame of the question (preprocedure).

"The nurse is caring for a patient going to have a colonoscopy. What is the MOST important thing for the nurse to assess?"

a. respiratory -No data about the patient having pre-exisiting respiratory problems, no data about whether or not sedation or anesthesia will be used (not all colonscopies are done with sedation or anesthesia, although it is kinder to do so). No information about whether this is a diagnostic or screening colonoscopy; therefore you have to consider that the vast majority of colonoscopies are performed on healthy, low-risk individuals. Remember this question is asking about the priority preprocedure assessment (see b)

b. fluid and electrolytes- All patients having a colonoscopy will have a significant bowel prep, which can result in loss of fluids and electrolytes. This would have the greatest impact on the patient's level of health/physiologic stability preprocedure. BEST answer because it can affect all patients and will have the greatest significance preprocedure. Fluid and electrolyte imbalance would have to be corrected before the procedure occurs.

c. comfort level - No data in question about pre-exisiting illness. Patient may be uncomfortable from the bowel prep, but this isn't life threatening.

d. nutritional status - Important to know, but response b would capture the most important pre-procedure nutritional concerns.

Again, I'm not saying I'm right, I'm just posting another way to look at the question and answers to point out that airway may not always be the best answer.

[Nuieve]

i'd definitely go with the B too... kaplan book teaches not to follow ABC blindly every time... first thing to do is analyze how the question relates to the answers... is ABC appropriate or not... only use ABC when it's appropriate... in this question it seems to be not

[suzanne4]

Fluid and electrolytes wins hands down.

Look at the question, exactly as it is written. Patients is going to have a colonoscopy. They have not had it yet. So there are no respiratory issues to consider from the sedation. It has not happened.

But what has happened? They have been given a prep to empty out their GI tract, and that means diarrhea; and therefore loss of electrolytes, as well as fluid.

-----------------------
Look only at the question as it is written. Do not read anything into it.
ABCs do not apply here as there are no issues with the respiratory status that were mentioned. Airway is not an issue at the moment from information given, and if the ABCs were involved. Which would you expect?
----------------------
It would be cardiac based on potential for arrythmias to be caused by a depletion of the potassium. Not respiratory. Remember that the patient has not had the procedure yet.

Common sense first in answering the question, then the ABCs get thrown in, but only if they are needed and required per the answer choices that you are given.

Any type of prep that is going to empty you out is going to have electrolytes as the first concern. Plain and simple.