A farmer spraying liquid suddenly falls down and is brought by his relative to the emergency room with low BP, constricted pupils, and an unconscious state. What is the priority nursing intervention?

1. A

   Report to poison control authority

2. B

   Maintain airway & start IV fluids

3. C

   Induce vomiting

4. D

   Administer antidote

Appeared in: AIIMS Delhi NO - 2017

Explanation

• The primary principle in any emergency is to address Airway, Breathing, and Circulation (ABCs) first.
• The patient is unconscious, which compromises their ability to maintain a patent airway, creating a high risk for obstruction and aspiration.
• Low blood pressure (hypotension) signifies circulatory failure, which must be addressed immediately with IV fluids to support vital organ perfusion.
• Establishing IV access is also a prerequisite for administering any necessary medications, including the antidote.
• Stabilizing the patient's vital functions is the absolute priority over definitive treatments like administering an antidote or reporting to authorities.

Why Other Options Were Wrong

• Option A: Reporting to poison control is a secondary action. The immediate priority is life-saving intervention to stabilize the patient's vital signs.
• Option C: Inducing vomiting in an unconscious patient is extremely dangerous and contraindicated. The lack of a gag reflex will lead to aspiration of gastric contents into the lungs, causing aspiration pneumonitis, which can be fatal.
• Option D: Administering the antidote (atropine and pralidoxime) is a crucial part of treatment but not the first step. Basic life support (ABCs) must be established first to ensure the patient is stable enough to receive the medication and that there is a reliable IV route for administration.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Priority nursing interventions in emergency management of poisoning in acute care settings.
• Nurses in the emergency department must be able to rapidly assess and prioritize interventions based on the ABC framework. This skill is fundamental to preventing patient deterioration and death.
• Recognizing toxidromes (a group of signs and symptoms constituting the basis for a diagnosis of poisoning) like the cholinergic crisis seen in organophosphate poisoning is a critical nursing skill for timely and appropriate intervention.
• Patient safety is paramount. Knowing contraindications, such as not inducing vomiting in an unconscious patient, prevents iatrogenic harm.

How to Approach the Question

• First, identify the question type. This is a clinical scenario asking for the 'priority' intervention, which means you must rank the options in order of importance.
• Analyze the patient's clinical presentation. The key findings are: unconsciousness, low blood pressure, and constricted pupils, with a history suggesting pesticide exposure.
• Apply the universal framework for emergencies: ABCs (Airway, Breathing, Circulation). Evaluate each option against this framework.
• Option B directly addresses Airway (maintain airway) and Circulation (start IV fluids for low BP). This aligns perfectly with the ABCs.
• Evaluate the other options. Reporting (A) and administering an antidote (D) are important but come after stabilization. Inducing vomiting (C) is harmful and contraindicated in an unconscious patient.
• Conclude that the intervention addressing the most immediate life threats (airway and circulation) is the highest priority.

Concept Tested & Keywords

• Concept Tested: Priority nursing interventions in emergency management of poisoning.
• Stem keywords: farmer, spraying liquid, low BP, constricted pupils, unconscious
• Lead-in keywords: priority nursing intervention
• Clinical cues: The patient's occupation as a farmer and exposure to a 'spray' strongly suggests pesticide (organophosphate) poisoning.
• Clinical cues: The combination of unconsciousness and low BP indicates a life-threatening emergency requiring immediate stabilization.

Question ID

Qxpsj1wvt_yUJEW5QcATWU

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 166-168

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 755-757

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 2263-2265