Test question - how would you answer?

[PJMommy]

In the first 24 hours post-op abdominal aneurysm repair, what is your priority nursing intervention?

1 - Pain management

2 - Blood pressure monitoring

3 - Wound assessment

4 - Patient ambulation

What would you choose -- and please tell me why...

I'll give you the "correct" answer later -- as well as what I answered...obviously not correctly! :)

[FranEMTnurse, CNA, LPN, EMT-I]

It all definitely comes down to critical thinking. We were all taught that in school. All are possible reasons for intervention, but B/P is the most logical. As was stated earlier, no B/P no pain either. Pt is in asystole. Aaaaaccckkk!

[Gromit]

Amen!

If the B/P is neglected in favor of pain mgmt, then the pt won't have any pain at all.... because he won't be alive.

Hehehe, reminds me of a course back when I was in paramedic school, and we were learning EKG interpretation, and ACLS. The instructor said that ultimately, all arrhythmias will resolve themselves if left untreated long enough.

When one of us asked "what? Why? How?" He said simply: They progress to asystole, and achieve room temperature. In short, they die!"

For some reason, that has always stuck with me.

Another truism of his, was that "Sick people have sick veins -they sick ones will generally be harder to start IVs on, than the ones who are healty, well, and feeling fine" (of course, those are also the ones least likely to be needing an IV)

Its an old thread, but the question caught my eye. I'd chosen B by following Maslow (decrease in BP means bleeding (in this case, a major complication to this type of surgery) -while pain can cause BP to elevate, if their BP is suddenly skyrocketing, or crashing to the bottom, their pain isnt relevant. Don't control the pressure and they won't have the pain, or life.

[FranEMTnurse, CNA, LPN, EMT-I]

Ooooooh! Thanks for the enlightenment. It's good to know. Now I know why my veins are sooo hard to gain access to, and sometimes when they're successful, the vein blows. And sometimes they just won't give any blood. Heh, they've turned stingy. Tightwads!!!

[jaimealmostRN]

I've found that when it says, "Priority" that means your ABCs or the 'what could kill you first' answer. So I pick BP.

[IMustBeCrazy]

BP without a doubt. Anytime there is surgery on blood vessels, there is always strict control of BP post op to ensure the sutures don't 'blow'. As others have said, the other stuff is important but only after you have controlled the BP.

[gij1]

I would pick BP monitoring, would be the first indicator of internal bleeding & pt. going into shock from loss of blood. ABC's (airway, breathing, & circulation) first when answering any test question. Pain is ruled out as the guy could still be sedated & not feeling pain within 24 hrs, ambulation obviously not the choice.

[Tweety, BSN, RN]

I would have picked BP as. From my experience I've noticed the surgeons like to have it within a certain paramenter, actually kind of on the low side because if the BP is too high it ruptures the repair. Obviously if it's too low, then that's the hypovolemia.

AAA repair and BP the first 24 hours is very tricky, not too high and not too low. I think 160 is the max they want to see, but it's surgeon's preference and don't quote me on that. :)

[Gromit]

I would pick BP monitoring, would be the first indicator of internal bleeding & pt. going into shock from loss of blood. ABC's (airway, breathing, & circulation) first when answering any test question. Pain is ruled out as the guy could still be sedated & not feeling pain within 24 hrs, ambulation obviously not the choice.

BP wouldnt truly be the first indicator, their level of consciousness would, but of what is offered, BP is the best choice. People will begin to have axiety, or that "impending doom" that they seem to get (and often can't figure out what is wrong, but know that something is).