Prioritizing care is very important in nursing.
It is an important part of nursing exams and in nursing practice. It is crucial in patient assessment. Prioritizing care is simply deciding which patient needs immediate care and which can be attended to later. This is not done by guessing or just giving in to which patient or their relatives are most compelling or pressurizing. The nursing ABCs is simply easy to remember mnemonics that help you to quickly detect life-threatening or crucial conditions in order of priority, especially when dealing with unresponsive or unconscious patients. It is also handy for answering nursing exam questions relating to prioritization correctly.
The ABC of nursing stands for Airway, Breathing, and Circulation are important physiological processes crucial for life and are factors determining the condition of a patient’s health. These processes operate in a cascade, clear airways are required for breathing, and proper breathing is vital for efficient circulation. When any of these stops, it is the end, hence they should be your top priority. Now let’s learn more about each of these vital processes and how to observe them
Airway refers to the channel through which air gets to the lungs of a patient. Airway assessment involves observing for airway blockage; this can be indicated by a change in the patient’s voice; airway is likely to be clear when the patient speaks clearly, partially blocked airway is usually noisy with low air movement while in the completely blocked airway, there will be neither air movement nor sound. A wheezing, respiratory sound can be heard when there is a partially blocked airway, and this is called Stridor. A “see-saw” respiration, also referred to as paradoxical chest movement, is a pattern indicating partial airway blockage characterized by a patient’s chest contracting when he/she inhales and expanding when he/she exhales, a direct opposite of normal chest movement. Other signs of airway blockage include using accessory muscles for breathing and tracheal deviation. Most of these signs are observed mostly when the patient is conscious. It is completely different when the patient is unconscious.
For an unconscious patient, the priority is to manage the airways and prevent hypoxia (a condition in which the entire body or parts of the body is deprived of oxygen). An unconscious patient’s airway can easily be blocked by a foreign body, vomit, or even the tongue. However, it can be opened by a “head tilt” intubation, oral airway, or “modified jaw thrust.”
Breathing is the next process to assess after ensuring the airways are free. Breathing is simply the process of inhaling and exhaling air. Normal rates of respiration for adults is from 12 to 20 breaths per minute. Deteriorating health condition is indicated by an increased respiration rate. On the other hand, a low respiration rate indicates bradypnea, leading to respiratory failure, hypoxia, or respiratory acidosis.
When a patient is unconscious and breathing properly, they can be placed in a recovery position while other important treatments are administered. For a patient with a breathing rate below the normal range, CPR or artificial respiration should be considered. For every patient, conscious or unconscious a nurse is expected to observe and look out for signs of respiratory distress or difficulties like cyanosis (blue discoloration of mucus membrane or skin, indicating insufficient oxygen supply) or using accessory muscles for breathing; accessory muscles help the patient increase the volume of air the taken in and out. A patient using accessory muscles for breathing usually pulse to breathe while speaking. Check for normal respiratory depth, rhythm, rate, chest movement/deformity; the chest should rise and fall uniformly as the patient breathes. Listening to the patient’s breathing can aid in the detection of Stridor or pneumothorax. Finally, listen for normal chest sound with a stethoscope.
Circulation is simply the continuous blood flow throughout the body. After ensuring that a patient is getting oxygen through free airways and efficient breathing, the next step is to ensure good circulation. This can be done by taking a carotid pulse or ECG to evaluate heart rhythm when the case is suspected to be a cardiac arrest. Examining the temperature and color of hands is a good way to determine good or poor circulation. Cold fingers and hands that are discolored (blue or pale) are signs of poor circulation. Checking capillary refill time is the time it takes for color to return to an area of the skin (usually the horsehead or fingernail) that cutaneous pressure has been applied to cause blenching, normal value is less than two seconds, and higher values may indicate circulatory shock. Other ways of circulation assessment are; measuring blood pressure and checking for signs of edema.
For Red Cross volunteers or other rescuers at the level of basic first aid who cannot accurately take carotid pulse but may still have to deal with patients who are not breathing, the C in the Nursing ABC is replaced with CPR compression. As they are required to immediately proceed to chest compression, they observe that a patient is not breathing. In nursing, time management is key. Hence, in prioritizing care and applying to nurse, ABC should be very fast. I advise nurses to do a quick look, listen and feel assessment, which should last between 30 seconds to 1 minute. Rapid assessment involves getting the patient to respond to a question while listening to their breathing and feeling their temperature.
Now let’s move on to how to apply the nursing ABC to answering examination questions.
Nursing examination questions concerning prioritizing care, you would be given a case scenario or information about a patient’s or a few patients’ conditions and you would be asked to state the first thing you would do or asked to identify the priority cases. The first thing you should think of is the nursing ABC. When asked to state the first thing you would do, read through the options and find the one that is about interventions or procedures that ensure that the airway is clear or breathing is efficient or proper blood circulation. When asked to identify the priority case, choose the case with conditions affecting their airway or breathing or circulation in the order, Airway, then Breathing and then Circulation. It is that simple.
Variations to the ABC mnemonics
There are several variations to the nursing ABC mnemonics.
These variations change the meaning of one of the acronyms, like the C in the nursing ABC is replaced with CPR or compression, used by the Red Cross Society. It is included as part of a bigger acronym, from ‘ABCD’ (used to train non-medical professionals in First Aid) to ‘AcBCDEEEFG’ (used by the UK ambulance service). Let’s go deeper:
Different procedures include a D to the ABC. The D may represent several things depending on what the trainer is teaching. The D could mean Decompression, Deadly Bleeding, Diagnosis (Differential), Defribilation (as part of the steps for treating cardiac arrest), and Dysfunction, Deformity or Disability (as a result of the injury).
Some assessment procedures add an E as part of the steps. Sometimes more than one E’s are added. Procedures that include an E step at that stage deviate from considering fundamental life support to considering causes. E can represent: Elimination (removal of all bodily discharge or foreign substances or excreted waste like vomit, feces, and urine), Evaluate (to prioritize care or seek further support), Examine and Expose (Usually to train the ambulance team to remove tight clothing and other obstructions to ease breathing or to treat wounds) Escaping Air (to check chest wound for air escaping indicating a punctured lung) and Environment (to keep the environment comfortable for recovery and take care of environmentally influenced symptoms like cold).
Some assessment procedures add an F as part of the steps. Which can represent: Family (Handle Family members, that is, keep them away from the patient while admonishing first treatment and get information about the patient), Fluids (to check for fluids like cerebrospinal fluid (CSF) or blood), Fundus (to train or remind rescue teams to check for pregnancy or how far the pregnancy has progressed when dealing with female patients)
Finally, some assessment procedures add a G. for some, the DEFG represent “Don’t Ever Forget Glucose” or the G which can represent just Represent Glucose (reminding rescue teams to carry out a glucose test on patients), Girl Check (to remind teams to check for pregnancy when dealing with females that are old enough to conceive, so they can take all necessary precautions in treatment not to harm the child) and the G may just mean, Go fast (to emphasize the need for speed in assessment and first treatment
you would agree now that nursing ABC is the fast and efficient strategy to identify and prioritize patients’ care, especially when dealing with seriously ill patients or when you are working in a bustling hospital where you have to deal with many patients. It is so essential that it has been expanded and included as part of a bigger acronym and used to train Red Cross volunteers, paramedics, and other healthcare workers. The nursing ABC is your ever-reliable guide. Never forget to use them in your nursing school clinical or nursing exams if you are a nursing student. It is also precious throughout the nursing practice. Always check for check and ensure the airway is clear, ensure breathing is healthy and blood circulation is efficient, with this you will never go wrong in prioritizing care.
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