I'm confused: HOB up then O2, or O2 then HOB up

[RunawayN]

Hey everybody, I need your help on understanding this priority question.

A client complains of severe SOB is diagnosed with CHF. The nurse observes falling pulse oximetry. Client's color changes to gray and she expectorates large amount of pink frothy sputum. The action of the nurse would be:

1) Check Vital Signs

2) Call the HCP

3) Position High Fowler's

4) Administer Oxygen

(question and answers reworded to prevent copyright claim)

Answer is 4 but I would think that Position high fowler's would be first followed by oxygen because repositioning also assists in Airway. Is it airway because it's a medical emergency?

I know, always ABCs but as I said before, isn't repositioning to high fowlers Airway also?

[kemifair]

Hey everybody, I need your help on understanding this priority question.

A client complains of severe SOB is diagnosed with CHF. The nurse observes falling pulse oximetry. Client's color changes to gray and she expectorates large amount of pink frothy sputum. The action of the nurse would be:

1) Check Vital Signs

2) Call the HCP

3) Position High Fowler's

4) Administer Oxygen

(question and answers reworded to prevent copyright claim)

Answer is 4 but I would think that Position high fowler's would be first followed by oxygen because repositioning also assists in Airway. Is it airway because it's a medical emergency?

I know, always ABCs but as I said before, isn't repositioning to high fowlers Airway also?

High fowlers first and then oxygen.

[1244 rock]

I would think because he is already showing signs of resp distress position head of bed won't fix it. 02 will

[RunawayN]

I would think because he is already showing signs of resp distress position head of bed won't fix it. 02 will

That's probably it. Also, I forgot the rule that if you can do only one thing, what would be it.

[obloom14]

Client's color changes to gray and she expectorates large amount of pink frothy sputum.

This already tells you the client is in distress.

Oxygen would work quicker than positioning them. What was the rationale?

[hbhalla]

exactly immediate relief ................02

[keepmovingrn]

I would say high fowlers to help with airway clearance and lung expansion, then O2. Of coorifice O2 seems like the easiest choice but you have to remember the pt has a airway clearance issue secondary to the frothy sputum, which is causing the SOB.

[lillymom]

The answer to that is definitely HOB first. O2 will help provide more oxygen but the main problem is that when someone with pulmonary edema is not sitting 9O degrees a greater amount of the lungs surface area is obstructed by fluids so giving more O2 doesn't help because there is not enough O2 exchange sites.

I was taught to think like a bottle of liquid 1/4 full. When the bottle is sitting completely upright it becomes collected in the bottom and only takes up 1/4 of the base of the bottle but when you start to turn the bottle on its side it spreads out more and covers much more of the interior of the bottle's wall, closer to 40-50%. This is what happens with pulmonary edema with L. side HF.

[RunawayN]

The rational: When dealing with a medical emergency, the rule is airway first, then breathing, then circulation. Starting oxygen is the priority.

[eatmysoxRN, ASN, RN]

In the real world I'd apply oxygen first IF it were available right then. We don't always have tubing in the room though. In that case, I'd put the HOB up while I called out for someone to bring O2 tubing.

I'd answer oxygen to the question though.

[RunawayN]

Thanks everybody. I think I got it :)