Nursing Priority vs First nursing action

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    We had an exam today and I struggled with one of the answers. The nurse is caring for pt. with HF who is experiencing dyspnea , and bilateral crackles, and pulmonary edema. What is the nurses priority intervention:
    Give PRN oxygen or give lasix as ordered.

    The answer is apply oxygen but I chose to give lasix. I know all about ABC's and Maslow. However, the reason why I chose to give Lasix as ordered is because the sx are caused by pulmonary edema and the underlying cause needs to be addressed.

    If the question would of asked what would should the nurse do FIRST... I would have picked to apply Oxygen.

    There is a difference between priority and what to do first. I'm a nurse in LTC ( LPN) and I have taken care many of residents with HF exacerbation. My first nursing action for any resident with SOB secondary to pulmonary edema is to apply oxygen. However, my priority is to make sure that the underlying cause is addressed in order to prevent and treat symptoms. Most of the time that priority interventions includes getting an order for IM lasix if not already ordered.
    Oxygen alone will provide temporary relief however it will not get rid of the pulmonary edema.
    Please help me to understand how oxygen is a priority instead of a first nursing action. Thanks.
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  4. 6
    Priority action and first action (at least in exam questions) are almost one in the same just stated different ways- why would it be your first action but you have a different priority? The reason that would be your first action is BECAUSE that's your priority. Priority actions are ALWAYS going to be ABC's if any of those are in the answer choices. Always go with an airway intervention if it's there
    Skips, joanna73, klone, and 3 others like this.
  5. 4
    I'm sorry, but I must respectfully disagree with you. When I think of priority, I automatically think of 1st, 2nd, 3rd, so that, like you said I would apply oxygen. Sure, you can have six things that are priority, but you must realize the true meaning of these questions. These questions are indeed asking what you need to do first. That's just how they word the questions.

    I think, however, the question would have been most clear if it used the word first. It is true that oxygen is only a temporary stabilizing measure, but you mentioned the rationale in your post: ABCs. No matter what you do in nursing, ensuring the ABCs always comes first. Oxygen qualifies under the airway or A part. To me, Lasix fits in under circulation, the C, since it would help the body get rid of the fluid volume excess associated with HF.

    That's how I would work the question.
    Skips, ohioSICUrn, annister, and 1 other like this.
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    In my first post, I am responding to the OP, just to clarify.
  7. 2
    I don't read the question like you do. For me, my first intervention directly reflects my priority action. They are essentially the same.

    Giving oxygen is the right choice. Why?
    My priority is A, B, C. Any patient that has a patent airway... you move on to B. You do any interventions you can with B that will have immediate effects and improvements. Oxygen will help immediately with resp distress, regardless of what the cause is. Then only after you have done all you can do for B, you give lasix.

    Because my priority is to get oxygen on board (regardless of Sp02, as patient will have increased oxygen demand and may become hypoxemic), my first intervention is to administer oxygen. Lasix is also going to act much slower then oxygen will in terms of releiving distress, although I know it's right up there on your list also.

    Another example: if someone had a pneumo/hemothorax.... for any reason really- say trauma (ok, a little ER bias here)- it doesn't matter what the fluid is from- whether its blood, or from CHF like your case, or air..... priority is getting oxygen in, then fixing the condition with lasix (your case) or a chest tube AFTER the oxygen.
    Skips and tokmom like this.
  8. 19
    I think you are over-analyzing.

    Oxygen will provide immediate, or nearly immediate comfort for the patient.

    Lasix, while necessary, will take longer to have an effect. Don't make your patient suffer air hunger one second longer than necessary while you address the underlying problem of excess fluid.
    Skips, joanna73, klone, and 16 others like this.
  9. 3
    another way to think about it is like....when they ask priority or first action questions- what's the ONE thing you would do if you could only do ONE thing... if a pt is having a hard time breathing *no matter the underlying issue* the ONE thing that would help them and prevent them from dying right then and there is oxygen. like the above poster said- after you fix the immediate issue at hand you can deal with the underlying cause of why that's happening to them in the first place to prevent this acute problem from happening again.
  10. 4
    Quote from NurseLoveJoy88
    We had an exam today and I struggled with one of the answers. The nurse is caring for pt. with HF who is experiencing dyspnea , and bilateral crackles, and pulmonary edema. What is the nurses priority intervention:
    Give PRN oxygen or give lasix as ordered.

    The answer is apply oxygen but I chose to give lasix. I know all about ABC's and Maslow. However, the reason why I chose to give Lasix as ordered is because the sx are caused by pulmonary edema and the underlying cause needs to be addressed.

    If the question would of asked what would should the nurse do FIRST... I would have picked to apply Oxygen.

    There is a difference between priority and what to do first. I'm a nurse in LTC ( LPN) and I have taken care many of residents with HF exacerbation. My first nursing action for any resident with SOB secondary to pulmonary edema is to apply oxygen. However, my priority is to make sure that the underlying cause is addressed in order to prevent and treat symptoms. Most of the time that priority interventions includes getting an order for IM lasix if not already ordered.
    Oxygen alone will provide temporary relief however it will not get rid of the pulmonary edema.
    Please help me to understand how oxygen is a priority instead of a first nursing action. Thanks.
    You are really splitting hair on this, and, well, sorry to tell you, your logic is just wrong here. Long term, yes, your want to treat the underlying problem...short term, save their life! (Lasix isn't going to do it in the short term) Your priority nsg. dx is impaired gas exchange. Your priority intervention is to apply O2. Your first intervention = your priority intervention. Yes, given the lasix ASAP after that, but, even if it is IV, it will take a bit to take effect. Apply the O2 first.
    GHGoonette, juzme, HoneyDew70, and 1 other like this.
  11. 0
    If you don't apply oxygen, then they suffer air hunger while you're waiting for the lasix to kick in. That could result in other serious complications. ABC's.
  12. 3
    When answering an exam question, always assume that the person marking it is a moron. That's what my brilliant tutor taught me when I was in nursing college, back in the days when people actually did mark papers, as opposed to a computer

    You always start with the first action you take, even if it seems so obvious you shouldn't need to mention it.
    joanna73, HoneyDew70, and CCL RN like this.


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