ABC's "old school"?!

[wantccu]

Reviewed our most recent respiratory test in class today. There was a question that had a patient in the ER with facial trauma and swelling and asked what the priority assessment was. Two of the options were to assess for patent airway and assess for a skull fracture. (Don't remember what the other two options are, they were irrelevant.). Anyways, I thought it was a no brainer and clearly airway, but the correct answer was skull fracture. My professor told us "I know that airway has been hammered into your brains, but that is old school".

I'm not really too concerned about one question on one test (although there was another-same deal, not airway), but I am concerned about the NCLEX. Are they moving away from ABC's as priority?

[Esme12, ASN, BSN, RN]

These questions are difficult to answer without knowing the exact question as Ashley has pointed out. depending on the other options that were presented the patient that is receiving the proper care (comatose patient who is being turned q 2 hour) would have a less change of complications.The point is they are all at risk ...however who is most at risk out of the group

[wantccu]

My rationale for the pneumonia one was that even though the patient is being turned every two hours to try to prevent stasis in the lungs, the patient is still comatose, bed ridden, not ambulating, not able to cough and deep breathe, use IS, or sit up. So while turning helps lessen the risk it doesn't eliminate it. It wasn't a "best answer" question, it was a "select all that apply". And the exact question was "which of these patients are at risk for developing pneumonia?" There were 6 or 7 options. In my mind its like saying an obese, bedridden, post op patient is not at risk for DVT because they've got scd's on. I'm not opposed to being wrong, it happens all the time in school and life - I just want to understand why so that I can be a better student and nurse!

And that scenario above WAS excellent, thank you!

[wantccu]

Thank you for all of the great replies! It's really awesome that you guys (who are clearly brilliant and accomplished nurses) take such time to help a lowly student that you don't know help understand these concepts. Very grateful!

[Esme12, ASN, BSN, RN]

Without the question and options available it is difficult to know what they wanted...you look at the answers and see what they have in common AND not in common and choose for there.

[wantccu]

I wish I could remember them Esme. It was pretty broad... Everything from someone in a homeless shelter to a postpartum mom. I'll let you know what my professor says about it. For now - on to cardiac!!

[Esme12, ASN, BSN, RN]

Let me know.....I'm really interested. remember we are here is you need us. I LOVE cardiac.

[nurseprnRN, BSN, RN]

Of course that comatose person is at risk for pneumonia, from stasis alone even c turning q2h. I like the way you think; do what your professor tells you, but keep thinking it out and I think you'll do well.

Ashley: Perfect example. You might be right that the professor wants to discourage the rote "airway is always first" answer; I wish the professor had then gone on to explain why in the way you did. Critical thinking!

[CT Pixie, BSN, RN]

I guess I'm old school ABC but ABC for me. Maybe the rationale for assessing for skull fracture before airway was if during the assessment you know there is a fx, you need to know which airway would be most appropriate? So it would then be assess before airway? i'm reaching here, but maybe that's how she/he was thinking about the question and the most appropriate answer.

[Esme12, ASN, BSN, RN]

Probably.....but it depends. Wht I have issue with is that the question stated skull fracture not facial fracture. If it was a facial frature that has a sirect impact on type of airway or the airway itself....if you look at the LaForte fracture information I provided it's easy to see how that impacts the airway directly.

to make a blanket statement that ABC is "old school" isn't necessarily true.....while the CPR guidelines have changed....the impact of the airway on the non coding patient remains the same. Most seasoned nurses actually have difficulty with some of these NCLEX questions because we have grown accustom to the real world of practice which differs from the "book" side of learning. We look at some of them and think in the real world I would do this first....which isn't the answer they ars looking for sometimes.