Walkthrough: Pharmacological and Parenteral Therapies Q14 – NCLEX-RN®

00:00 The nurse is caring for clients who present with opioid overdoses. Which client does the nurse see first? Well, this is kind of an unusual situation but these are common types of questions that you'll see in NCLEX and maybe even your nursing school exams because they're seeing if you can prioritize who is in the most danger and you need to intervene and work with them first. So, here's the strategy I want you to use on this. First of all, we know what's unique about these patients is that all of them have opioid overdoses. So you might want to think before you look at the answer choices "What do I know, what are the signs and symptoms of opioid overdose?" Then, you're going to start with whatever patient you want, it doesn't matter. You can start with patient 3, patient 1, patient 2, patient 4. It doesn't matter but start with that client, use them as a baseline, then compare them to one of the other clients decide who needs to be seen first between those 2, eliminate the one and then go on and compare it with the remaining 1 and the remaining 1, do the same process. That is actually one of the best strategies in making sure you don't miss something in one of the patient. So, there you go. You've got 4 of them.

01:15 You've also got your scratch paper where you can write down the numbers; number 1, number 2, number 3, and number 4 and work the process. So, take your time, do your best, think about your thinking, and then come back we'll walk through it together. Okay, how'd you do? This feels kind of weird. Doesn't it? I probably should have told you before you pause the video, sometimes students struggle with these questions because there is more than 1 patient that needs to be seen. That's really true and remember this is NCLEX world. All of these people will be seen. Right? They all deserve to be seen, they have the right to be seen, they will be seen. This is just the way they ask you a question. Do you recognize what's the highest priority? Do you know how to look at patients and say "That's the patient I need to go see first." Okay, so let's say I'll start with number 3 so we know that all 4 of them are opioid overdoses. Now, number 3, a sedated client with analgesia and is constipated. Okay, so they're sedated, they have analgesia and they're constipated. Well that's my baseline. I'm going to compare them to another client and see who should see me first, who should I go see first. So sedated and constipation, yeah they need to be seen but is that my top priority, don't know til I compare them. So, I'm going to compare number 3 to number 4. I think they're right close to each other. A client with dysphoria, runny nose, and yawning. Okay, that is actually, and that seems kind of weird. What does that have to do with opioid overdose? Well, those are actually all symptoms of opioid withdrawal.

03:08 Right? Their pupils will be dilated, they've got their stomach is really upset, fever, sweating, it's miserable. But in this case, is that the first person I need to see? I don't know, but I know that number 4 is going to be a higher priority than my patient with constipation. So, so far number 3 you are out. Number 4 you are in for now, don't get comfortable. Okay, let me compare number 4 to number 1. A client with fast breathing, agitation, and dilated pupils. Well, is that a sign of opioid overdose? No, the dilated pupils is a sign of amphetamines or cocaine. So, something else is going on, this is not somebody we're worried about having respiratory problems because why. Well, look at that. The client with fast breathing, agitation, and dilated pupils, they are not in respiratory distress and we know it's likely not the morphine going on here. So, number 4 you're a priority over number 1 so I'm getting rid of number 1. Now, looking at my scratch paper I would have number 2 and number 4 left. So look at number 2, a comatose patient, okay so they're out, with 10 breaths a minute and pinpoint pupils. Well, 10 breaths a minute, that is high, low or normal? Low. Is there a connection to opioids and respiratory depression or supression? Absolutely. So I have an abnormally low breath rate, I know that they have had opioids, they are comatose, and they have pinpoint pupils. So, who am I going to see first, 2 or 4? Yeah, it's number 2. Now you would say "Hey prof Lewis, I would have got that answer right without eliminating the other 3. You may have on this question, but that strategy is not going to serve you well long term. So, it's not a big deal, do the work, you'll learn stuff as you go along like "Oh yeah, dilated pupils, that's not morphine, right." That's another kind of medication like amphetamines or cocaine. Those are other street meds that you'll see people take. So, take the time, write the notes down what's beneficial to you, what you want to remember from this question, and then I want one more point before we go along. Now, you see this client, it's not part of this question, just part of this content. If they have comatose, 10 breaths a minute, pinpoint pupils, what is the medication we should give them to help reverse the opioids? Yeah, there you go. Narcan. That is the trade name for the medication for naloxone that you would give to a patient who needs their opioid reaction or response reversed. Okay, excellent. Really good job, keep going. Join us for another question as soon as you're ready.