What would be the nursing responsibility while caring for a patient with cardiac arrest?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2021

Medical & Surgical Nursing

Medium

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2021

Explanation

Current resuscitation guidelines from the American Heart Association (AHA) prioritize a C-A-B sequence: Compressions, Airway, Breathing.
The first step is always to initiate high-quality chest compressions to circulate blood.
Since starting compressions is not an option, the next immediate priority is to establish an open airway to prepare for ventilation.
Establishing an airway (A) takes precedence over cardiac monitoring, IV access, and pulse oximetry in the initial moments of resuscitation.

Option A: Initiating cardiac monitoring is critical for rhythm analysis and defibrillation, but it occurs after starting high-quality CPR (Compressions and Airway). The immediate need is to restore circulation and secure an airway.
Option B: Providing intravenous (IV) or intraosseous (IO) access is part of advanced life support to administer medications. It is performed after high-quality CPR is established and is not prioritized over basic life support actions like opening the airway.
Option D: A pulse oximeter is ineffective and unreliable during cardiac arrest due to the absence of pulsatile blood flow to the peripheries. Therefore, obtaining a reading is not a useful or priority action.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Prioritization of nursing interventions during cardiac arrest in acute care settings.
The shift from A-B-C to C-A-B in resuscitation guidelines was a major change, emphasizing that the delay in chest compressions is more detrimental than the delay in ventilation. Starting compressions first is the most critical intervention to improve survival.
As a nurse, immediately recognizing cardiac arrest, calling for help, and starting high-quality chest compressions are the most important initial actions.
What if? If the patient was a child, the sequence might differ. For witnessed, sudden collapse in children, C-A-B is used. However, for unwitnessed collapse or asphyxial arrest (like choking or drowning), the sequence may revert to A-B-C, as respiratory issues are a more common cause.

How to Approach the Question

First, identify the clinical situation: a patient in cardiac arrest, which is a life-threatening emergency.
Recall the standard protocol for this emergency. For cardiac arrest, this is the Basic Life Support (BLS) algorithm.
Remember the priority sequence taught in BLS, which is C-A-B: Compressions, Airway, Breathing.
Evaluate the given options against this priority sequence.
Option A (Monitoring), B (IV access), and D (Oximetry) are all part of resuscitation but are not the immediate priority over Airway (A), which follows Compressions (C).
Since 'Start Compressions' is not an option, select the next step in the C-A-B sequence, which is 'Establish an open airway'.

Concept Tested & Keywords

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