week1

ABC Priority Framework
  • Always treat in order: Airway → Breathing → Circulation
  • Think of Maslow’s pyramid applied to physiology—each level depends on the one below it
  • If airway is clear but breathing is impaired, breathing becomes next priority, etc.
Distinguishing the ABCs

• Airway

  • Patency of upper airway (obstruction, swelling, vomitus, foreign body)
  • S/S: stridor, silent airway, choking, anaphylaxis
  • Key actions: upright position, head-tilt/chin-lift, suction, artificial airway, give O₂

• Breathing

  • Gas exchange/ventilation problems in lungs
  • S/S: low SpO₂ (e.g., <90%<90\%), cyanosis, accessory-muscle use, ↑/↓ RR, nasal flaring
  • Key actions: assess lung sounds & RR, sit upright, O₂, continuous monitoring

• Circulation

  • Pump & perfusion (heart, vessels, blood volume)
  • Assess: BP, HR, cap refill ≤2 sec\le 2\text{ sec}, color, urine output
  • Key actions: fluid or blood, control bleeding, vasoactive meds
Delegation Principles
  • Accountability: RN remains responsible for outcome after delegating
  • Scope & Competence: only delegate tasks within designee’s legal scope and proven skill set
  • Hierarchy: delegate to same or lower licensure level (RN→RN/LPN/AP; not RN→NP/MD)
Who Can Do What?

• Registered Nurse (RN)

  • Initial/comprehensive assessments & nursing diagnoses
  • Initiate/update care plans; initial teaching & discharge
  • IV meds, blood products, invasive/complex procedures, unstable/critical pts

• Licensed Practical/Vocational Nurse (LPN/LVN)

  • Focused assessments after RN’s initial
  • Oral, IM, SQ meds; monitor IV infusions
  • Wound care, catheters, reinforce teaching, care for stable pts

• Assistive Personnel (AP/CNA)

  • ADLs, hygiene, feeding, ambulation, routine VS on stable pts, I&O, simple specimen collection
  • No assessment, no teaching, no judgment-based tasks
Additional Priority Frameworks

• Acute vs. Chronic

  • New, sudden, worsening = higher priority (e.g., new confusion, new SOA)
  • Chronic/expected findings handled after acute needs unless unstable

• Urgent vs. Non-Urgent

  • Delay of urgent care → harm (e.g., ABC compromise, chest pain, stroke S/S, anaphylaxis)
  • Non-urgent = stable chronic issues, routine care, mild symptoms

• Least Restrictive/Least Invasive

  • Start with simplest, safest intervention that meets need
  • Examples: verbal de-escalation before restraints; ambulate vs. bed rest; diet/fiber before laxatives

• Acuity Levels (high → low)

  1. Life-threatening/rapidly deteriorating (severe respiratory distress, MI, stroke)
  2. Serious but stable (pneumonia w/ adequate SpO₂, post-op pain controlled)
  3. Minor/non-urgent (mild dehydration, routine follow-ups)
Quick Recall Numbers & Signs
  • Normal cap refill: ≤2 sec\le 2\text{ sec}
  • Hypotension (shock risk): SBP <90 mmHg<90\text{ mmHg}
  • Hypoglycemia concern: <70 mg/dL<70\text{ mg/dL} (watch for shaky, sweaty, light-headed)
  • Critical SpO₂: <90%<90\%
Exam Strategy Tips
  • Ask: “Which choice fixes Airway/Breathing/Circulation first?”
  • Delegation MCQs: eliminate options that exceed designee’s scope or skip RN accountability
  • Look for words like new, sudden, acute, severe, unable—they flag priority
  • Least-invasive answers often include positioning, communication, or simple comfort before drugs/procedures