Recognizing Cues
A nurse notes a patient has a respiratory rate of 28 and is using accessory muscles. What is this an example of?
Recognizing abnormal cues
What does analyzing cues involve?
Interpreting and linking data to patient condition
What framework is commonly used for prioritization?
ABCs (Airway, Breathing, Circulation)
What is the next step after identifying a priority problem?
Plan interventions
What does evaluation determine?
If interventions were effective
Name two types of cues a nurse collects during assessment.
Subjective and objective data
Which is priority: pain level 8/10 or oxygen saturation 88%?
Oxygen saturation 88%
A patient is hypoxic. Name one nursing intervention.
Administer oxygen
A patient’s pain decreases from 8 to 3. What does this indicate?
Intervention was effective
A patient reports chest pain rated 8/10. What type of cue is this?
Subjective cue
Why is clustering cues important?
Helps identify patterns and potential problems
What does prioritizing hypotheses mean?
Determining the most urgent patient problems
Why should interventions be evidence-based?
To ensure safe and effective care
What should the nurse do if outcomes are not met?
Reassess and modify plan
Oxygen saturation drops from 98% to 90%. Why is this important?
It is a significant change indicating potential deterioration
A patient is at risk for falls. Name one intervention.
Bed alarm / non-slip socks / assist with ambulation
Why is continuous evaluation important?
Patient conditions can change rapidly
A nurse reviews lab values and notices potassium is 2.9. What is this considered
Critical/abnormal cue requiring attention
What is a risk of failing to analyze cues correctly?
Missed or delayed diagnosis/intervention
What principle guides prioritizing life-threatening vs non-life-threatening issues?
Maslow’s hierarchy / safety first