Chapter 2: Patient Assessment

2.13 Quick Priority Assessment (QPA)

Critical Thinking Exercises: Questions, Answers, and Sources / References

Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.

  1. Your initial assessment of a patient reveals that the patient is having trouble speaking. What would be your next steps?

Assess ABC (airway, breathing, circulation) followed by a neurological nursing assessment including vital signs, Glasgow coma scale, and pupil response. Elevate head of bed in case there is a choking risk. Notify the most responsible physician/prescriber for follow up investigations.

 

2. Your patient is returning from surgery following an appendectomy. Outline an assessment plan using a systems approach.

 

Suggested Approach #1: QPA

Steps

Additional Information

A Airway. Does the patient’s position allow their airway to be patent? For example, if someone has slumped down in the bed or wheelchair, they may require re-positioning.
B Breathing. What is the quality of the breathing? Are there any suggestions that breathing is compromised? Any concerns require further investigation.
C Circulation. What is the patient’s colour. Quickly palpate extremities for warmth. Any concerns require further investigation.
I In. What is going in? Identify every solution going into the patient. Follow all tubes from their source to the patient. Are the volumes adequate? Are the rates accurate? Are the tube insertion sites intact and free of complications? Is the safety equipment (i.e., pumps) plugged in and working? Is there any evidence of complications?
O Out. What is coming out? Are dressings dry and intact? Are any drainage tubes present? If so, what is the nature of the drainage? Follow all tubes from their source to the patient. Are the tubes patent? Are the tubes secured to avoid accidental or unintentional removal? Is there any evidence of complications?
P Pain. Is the patient comfortable? Are analgesics given previously still effective? Does the patient need repositioning? Are they too warm or too cold? Do they need to use the washroom?
Safety
  • Is the oxygen and suction equipment present and working?
  • Are the side rails up?
  • Are the patient’s belongings and call bell within reach?
  • Are restraints applied correctly?
  • Are the bed or wheelchair brakes applied?
  • Is the area clutter free?
  • Does the patient have a clear path to the washroom?
  • Always ask, “is there anything you need from me at this time?”

Adapted from:

Christensen, B. L., & Kockrow, E. O. (1999). Quick patient assessment using ABC I&0 PS. In, Foundations of nursing (3rd ed.).  http://www.cabrillo.edu/~ttaylor/Prep_forms/Quick%20Patient%20Assessment.pdf 

Suggested Approach #2: Systems

System

Details to Assess in Each System

Neuro
  • Orientation status
  • Pain
  • Consider what kind of anesthetic/meds the patient has had, and how these might affect neuro status.
  • Numbness, tingling to limbs?
Respiratory
  • Lung sounds
  • Quality of respirations
GI
  • Palpate abdomen
  • Assess bowel sounds
  • Determine if oral intake is allowed
GU
  • Is a Foley catheter present? If yes, urine character (colour, volume)?
  • Palpate suprapubic abdomen for distension suggesting urinary retention.
CV
  • Vital signs T, P, BP, SpO2
  • Check OR/PAR records for estimated intraoperative blood loss.
  • IV fluids
  • Fluid balance status in the OR/PAR
Musculoskeletal
  • Ability to move all limbs.
Integument
  • Presence of dressings and drains, and condition of these
  • Areas of pressure injury
  • Type / # / condition of IV insertion sites
Psychosocial
  • How is the patient feeling about things at this point?
  • Do they have any concerns that need immediate attention

 

Note: This exercise can be a valuable discussion. Invite participants to provide rationale for their decisions. This should help students begin to link assessment with potential and actual health issues.