Priority assessment..Respiratory or cardiovascular?

rocket surgery · Nov 4, 2011

My professors continually drill it into our brains that the correct order is ALWAYS

1. Airway

2. Breathing

3. Circulation

4. Pain

So I would choose Breathing before Circulation. The reason is that the untreated SOB will kill you before the untreated hypokalemia will. Hope this helps. :)

AaronsMommyxx · Nov 4, 2011

I agree with breathing. but the fainting is also a reason to look at neuro as a second priority.

xtxrn, ASN, RN · Nov 4, 2011

Hi,
I am having trouble figuring out which one would be the priority assessment for a patient with eating disorders and having shortness of breath + hypokalemia. Would it be respiratory? I thought I would get the oxygen saturation and see if the person needs oxygen adminstration. But, then, he has hypokalemia as well. It can lead to dysrhythmia. (I don't have the blood pressure readings because it was not provided on the case scenario).
Getting more confused..could it be neurological since hypokalemia can hinder with the Na-K pumps in the brain and something may go wrong with the patient's LOC?
Forgot to mention that the patient had a fainting episode too.
I have a huge physical assessment test tomorrow and I'm freaking out!
Any timely help will be appreciated! =)

OK- you need more lab work :)

Potassium? How low?

H&H? (could have an effect on SOB)

Get the O2 sats, and vitals; also, is this person on telemetry?

I've worked with ED patients... the cardiac aspect of the potassium depletion is HUGE. I'd go with an arrhythmia with this (ED patients can have seizures, but if it's listed as "fainting", many of the causes of fainting are cardiac related).

What about dehydration?

Good luck on the test :)

Blu rose · Nov 5, 2011

I agree! Thanks for your input :)

Blu rose · Nov 5, 2011

I agree that the data given is insufficient. If this was a 'real' patient, I would get more lab work but, with a scenario written on a piece of paper, you can just make assumptions.

Oh, how come I didn't tell that the potassium level was 2.9 mEq/L :/

I didn't get this scenario on the test but, of course, the comments helped me think better. I passed the test! Thanks a lot :redbeathe

NCRNMDM, ASN, RN · Nov 7, 2011

Hi,
I am having trouble figuring out which one would be the priority assessment for a patient with eating disorders and having shortness of breath + hypokalemia. Would it be respiratory? I thought I would get the oxygen saturation and see if the person needs oxygen adminstration. But, then, he has hypokalemia as well. It can lead to dysrhythmia. (I don't have the blood pressure readings because it was not provided on the case scenario).
Getting more confused..could it be neurological since hypokalemia can hinder with the Na-K pumps in the brain and something may go wrong with the patient's LOC?
Forgot to mention that the patient had a fainting episode too.
I have a huge physical assessment test tomorrow and I'm freaking out!
Any timely help will be appreciated! =)

Is the patient having severe shortness of breath, or is the shortness of breath mild? Also, how low is the potassium? A potassium that is far from the baseline can have fatal consequences, and correcting it should be your first priority if the patient isn't in severe respiratory distress. I would do a thorough assessment of breath sounds, work of breathing, respiratory rate, and oxygen saturation. Then I would move on to assess heart sounds, quality of pulses, capillary refill, heart rate, and blood pressure. I would also include a neuro assessment because severe hypokalemia, hypoxemia, or low oxygen saturation can cause confusion or altered mental status. I would review the potassium value, and if I thought it was significantly low, I would make that my first priority. However, if the potassium isn't significantly low, and the patient is really struggling to breath, then that is your first priority. Always prioritize by what will kill your patient first. In the face of severe respiratory distress, the potassium isn't all that important. If the patient has a potassium of 2 and only has 3 respirations per minute, you are going to address the respirations first because it doesn't matter what their potassium is when they go into full cardiac arrest from hypoxemia. If, however, the respiratory rate is 14 and only slightly labored, and the potassium is 2, then you are going to address the hypokalemia and any symptoms of it first because that could be a fatal potassium level.

Blu rose · Nov 10, 2011

Is the patient having severe shortness of breath, or is the shortness of breath mild? Also, how low is the potassium? A potassium that is far from the baseline can have fatal consequences, and correcting it should be your first priority if the patient isn't in severe respiratory distress. I would do a thorough assessment of breath sounds, work of breathing, respiratory rate, and oxygen saturation. Then I would move on to assess heart sounds, quality of pulses, capillary refill, heart rate, and blood pressure. I would also include a neuro assessment because severe hypokalemia, hypoxemia, or low oxygen saturation can cause confusion or altered mental status. I would review the potassium value, and if I thought it was significantly low, I would make that my first priority. However, if the potassium isn't significantly low, and the patient is really struggling to breath, then that is your first priority. Always prioritize by what will kill your patient first. In the face of severe respiratory distress, the potassium isn't all that important. If the patient has a potassium of 2 and only has 3 respirations per minute, you are going to address the respirations first because it doesn't matter what their potassium is when they go into full cardiac arrest from hypoxemia. If, however, the respiratory rate is 14 and only slightly labored, and the potassium is 2, then you are going to address the hypokalemia and any symptoms of it first because that could be a fatal potassium level.

Well, the potassium level is low- 2.9 mEq/L and I don't have the reading for oxygen saturation on the scenario (I would get it first if it was a real patient). Whatever you said makes perfect sense. I appreciate your help.

nurseygurlie · Nov 14, 2011

Is the patient having severe shortness of breath, or is the shortness of breath mild? Also, how low is the potassium? A potassium that is far from the baseline can have fatal consequences, and correcting it should be your first priority if the patient isn't in severe respiratory distress. I would do a thorough assessment of breath sounds, work of breathing, respiratory rate, and oxygen saturation. Then I would move on to assess heart sounds, quality of pulses, capillary refill, heart rate, and blood pressure. I would also include a neuro assessment because severe hypokalemia, hypoxemia, or low oxygen saturation can cause confusion or altered mental status. I would review the potassium value, and if I thought it was significantly low, I would make that my first priority. However, if the potassium isn't significantly low, and the patient is really struggling to breath, then that is your first priority. Always prioritize by what will kill your patient first. In the face of severe respiratory distress, the potassium isn't all that important. If the patient has a potassium of 2 and only has 3 respirations per minute, you are going to address the respirations first because it doesn't matter what their potassium is when they go into full cardiac arrest from hypoxemia. If, however, the respiratory rate is 14 and only slightly labored, and the potassium is 2, then you are going to address the hypokalemia and any symptoms of it first because that could be a fatal potassium level.

I agree, pick the killer answer!! The first thing I do with any nursing question is try to figure out if anyone is about to die from something. If not, then I go back and prioritize.

You should also get more familiar with how to prioritize and what parameters, like ABC's (airway, breathing, circulation), Maslow's Hierarchy of Needs, physiological before psychosocial, and unfortunately in the world of NCLEX critical before pain. There are always exceptions to the rule, but a good NCLEX review book can help explain how to attack priority questions.

Blu rose · Nov 22, 2011

Thanks for the suggestion :) We don't have NCLEX in Canada, though

loveoutloud · Nov 22, 2011

respiratory i'd say

xtxrn, ASN, RN · Nov 22, 2011

Hypokalemia is a common cause of death in eating disorders. SOB is not.

Irregular heart rate will effect perfusion, and with perfusion altered, respiration will be effected.

But, dollars to donuts, the potassium (while not horribly low) is worth replacement- and not knowing how often or how severe the eating disorder behavior is going on (or the specifics- diuretics, laxatives, vomiting, excessive exercise, starvation - all or some of those) doesn't help- but the fainting also suggest cardiac arrhythmia in someone who has not been noted to have cardiac abnormalities.

She can't breath because she's trashed her potassium, and has an irregular heart rate, activity intolerance, and causing fainting. Another purge could leave her dead on the bathroom floor. No joke.

You MIGHT hear irregular heart rates- but it's more likely to show up on an EKG that is ongoing for a bit. Hypokalemia has a specific EKG pattern.

Cardiac: hypokalemia

fainting

weakness/SOB

Respiratory: she has symptoms, but not caused by a pulmonary problem. Address it as part of the cardiac issues.

Neuro- it's possible for eating disorder patients to have abnormal EEGs and brain shrinkage (severe cases) but with the only semi-neuro symptom being fainting, I'd still go cardiac.

Good luck :)