Ask Graph, Why is it so important in prioritization
questions? We were taught ABC's, airway,
breathing, circulation. But those are really confusing
for me. So when I look at a question and
I use the method, reading the last part of the question first,
I'm looking for these clue words first.
Initial priority, urgent, most concerning, immediate report to
HCP. Do you see how quickly I knew
those 7 words? The minute I see one of those
words, I know it's a prioritization question because
I'm going to see these patients first.
Initial priority, urgent, most concerning, immediate report to
HCP. So I'm looking for something
that I'm freaking out about. But airway, breathing,
circulation didn't cut it for me.
So as I wrote questions, as I did questions, I started seeing
patterns develop and that's where Ask Graph came about.
So what does Asgraf mean? Well, the first A is airway.
You can't get around airway, Airways compromised.
We are seeing that patient first.
So what types of clues are we going to see when it comes to
airway? Look for certain terms like
strider, look for angioedema, asphyxiation, same facial hair.
How about overdose of things like opioids or insulin where
the respiratory rate drops to 6:00 or 8:00?
Look at aspiration. These are just some of the clue
words that they may throw at you screaming that this is airway
and if you see airway, you're choosing it.
The S is sepsis. Now from sepsis on whatever I
talk about, find me one of them. And if you find more than one of
them, ask yourself these two questions.
Who do I have less time with and what more can I do?
So these two questions again, who do I have less time with and
what more can I do, are going to help you decide if you see more
than one of ASGRAF. Again, airway above all else but
the s s sepsis. Now with sepsis, we may see a
triad where we have somebody who's febrile above 100.4
Fahrenheit. They may be tachycardic and
hypotensive, and it'd be great if the boards gave us that.
That'd be amazing, but they're not.
The boards are all about critical thinking and logical
deduction. What does that mean?
What if I gave you a patient who was post op post procedure, had
purulent discharge at the incision site and was
tachycardia, heart rate of 127. Did I give you their blood
pressure? No.
Did I give you a fever? No.
So what does that mean? You have to logically deduce by
purely discharge and tachycardia that this patient is in fact
septic. This is what the boards are
testing. It's your job to understand and
logically deduce and use your critical thinking that this is
the one that we're going to see first.
Initial priority, urgent, most concerning, immediate report to
HCP. The K stands for potassium, more
specifically changes in potassium.
Notice I didn't say hypo or hyperkalemic, I said changes in
potassium, which means low potassium or high potassium can
cause the most deadliest dysrhythmia that we are freaking
out about, ventricular fibrillation.
We talked about that extensively in the EKG lecture, but
potassium predominantly controls the ventricle, which means any
change in potassium can throw that ventricle into a
dysrhythmia. And the one that we're freaking
out about is ventricular fibrillation, how to identify
it, do the strip, how to treat it all in our EKG lecture.
So we've got airway sepsis, potassium that's ask graph
starts with glucose below 70. Now hypoglycemia is something
that we're freaking out about. Sugar runs our body, it runs
almost every metabolic pathway. So now if we don't have it,
maybe too much insulin, maybe their pump is not being
regulated properly, maybe they're trying to overdose,
suicidal ideation, a little bit of mental health there.
And now their blood glucose drops below 70, and they'll tell
you specifically that this patient has a blood glucose of
56, of 62. We're freaking out about that.
They're going to shut down, they're going to become
comatose, and they're going to die.
The R in Asgraf is lethargy or grunting.
We use these two terms in pediatric patients.
How else you describe a child that is not responding?
They were lethargic. They're grunting these two words
in a pediatric patient and not always in pediatric patients,
but usually you'll see these two words to indicate that this
child is in grave danger. They're the ones we're freaking
out about. The A is altered mental status.
Look for these clue words, seizures, hallucinations,
delusions, delirium. All these words indicate that
this patient all of a sudden in the last hour acute has suddenly
had a change in mental status and we're freaking out about it.
But again, look at the latter part of what I just said.
All of a sudden in the last hour acute.
Why did I give you time? Which leads me to another test
taking strategy. If you see time, age, gender,
anatomical location, you are paying attention to it like a
hawk. I gave it to you for a reason.
I said all of a sudden I said acute.
I said left lower extremity. I said 83 year old male.
I said it for a reason, a 17 year old female.
Why did I give you those? I gave it to you for a reason.
So pay attention. So with altered mental status,
look at that last hour acute, all of a sudden what happened?
The P is peritonitis. So what is the peritoneum?
The peritoneum in cases the GI tract and when something is
wrong, inflammation, infection, hemorrhaging, it is going to
irritate the peritoneum. They're going to develop
peritonitis and look for the cool words guarding rigidity
board like abdomen. All these are indicating to you
that something in that GI tract in that peritoneum is wrong.
So we're going to see that patient first, initial priority,
urgent, most concerning, immediate report to HCP.
The HNS graph is twofold. We've got the first H, which is
hemorrhaging. In hemorrhaging, we're going to
see a patient that's tachycardia and hypotensive.
Again, it'd be great if they told us that, but how about
swelling at the incision site with a blood pressure of 80 /
60? Did I give you that they're
tachycardic? Did I tell you that they're
bleeding? No, it's your job to logically
deduce and use your critical thinking skills.
The last one is heart attack. So myocardial infarction.
Same thing. We talked about this extensively
in our cardio lecture. With a heart attack.
Look for the signs and symptoms of a heart attack.
That diaphoresis, dizziness, chest pain radiating to the left
arm, up the jaw. Look for the signs and symptoms
because this patient is having a heart attack and we need to do
something right now. We don't have time.
All of these are your prioritization situations.
Are they going to be 100% of the time?
No, absolutely not. But it's going to hold true
about 85 to 90% of the time. And if you're scoring 85 to 90%
on prioritization, it's going to bring whatever else you have up,
which is going to ultimately help you pass.
That's why our students are doing so well.
We're not looking for airway breathing circulation.
We're looking for one of ask wrap.
You combine that with the method and now the entire test changes.
Now you're not making mistakes. Now you're not second guessing
yourself using the method. So make sure you watch the
method, watch me utilize the method and start using it in
your day-to-day practice. The second part about
prioritization is I took it a step further.
When you see a patient that's post op, post procedure, you're
going to look for ASH of ASGRAF. Think about it, if we're taking
a patient into a procedure or into an operation, we're
probably going to sedate them, maybe intubate them.
You think Airways is going to be compromised?
Absolutely. Can they develop, alter mental
status, maybe a drug, drug interaction?
Absolutely. Sepsis, Well, are we doing
something invasive 100% and then hemorrhaging, invasive heart
attack. Doctor Z, how does that work?
Don't we get cardiac clearance? Ever heard those terms before
cardiac clearance before we send somebody in to do a procedure?
Absolutely, because we don't want to put stress on the heart.
So more specifically, if you see a patient post op post procedure
in your question stem, now we're looking for ash out of ash
graph. So pay attention to this
prioritization test taking strategies because you're not
going to get it anywhere else. These are the advantages that
you're going to get here at NCLEX.
I yield. So make sure you know it down
pat. And if you have any questions,
feel free to reach out to us. Take care.