Assignment
Case Scenario
Identification
Mr. Hassan Faizan, 62 years old.
Situation
Hassan is here in the emergency department due to pain. Current pain score is 8/10. Hassan's wife Farah and one of his sons are in the waiting room; they are stressed.
Background
Allergies: - nil
Medications: lipitor, atenolol
Past history: hypertension, elevated cholesterol
Last ate & drank: 2 days ago, due to nausea
Events:
Suffering right sided flank pain for two days
Hassan's weight is 130kgs. Hassan is married to Farah aged 58 years. They have two sons who live nearby and visit regularly. Farah and their son are worried as they do not understand what is happening.
Assessment
Temperature = 38.0°C
Pulse rate = 116 beats per minute, capillary refill = 3 seconds
Respiratory rate = 26 breaths per minute
Blood pressure = 115/70 mmHg
Oxygen saturation = 96% on room air
GCS = 15
Hassan's current pain score is 8/10, localising to his right flank and radiating to his groin region. He is diaphoretic, grimacing, and crying intermittently. The urine is blood stained. The pain has been low to moderate intensity for several days, at midday the pain intensity increased dramatically.
The family are stressed as they do not know what is wrong with Hassan and suspect the worst. Hassan and Farah were born in Iran and moved to Australia 6 years ago. They are both fluent in conversational English but have only moderate English reading skills.
Recommendations
Complete your secondary assessment so that you understand what pathophysiology is occurring. Once you have planned your care, implement it but make sure that it adheres to the NSQHS standards and supports Hassan's and his family's needs
Part I
Investigations were completed and the results were C-reactive protein =16 mg/L, white cell count = 20,000/μL, and a urolithiasis of 8 mm diameter was in the right ureter.
• Conduct a focused assessment of the neurological system.
o What information from the case scenario informs the neurological assessment?
o What information do you need to complete the neurological assessment?
o What neurological system investigations are required for this patient?
o If the function of the neurological system has changed, why?
• Conduct a focused assessment of the respiratory system.
o What information from the case scenario informs the respiratory assessment?
o What information do you need to complete the respiratory assessment?
o What respiratory investigations are required for this patient?
o If the function of the respiratory system has changed, why?
• Conduct a focused assessment of the cardiovascular system.
o What information from the case scenario informs the cardiovascular assessment?
o What information do you need to complete the cardiovascular assessment?
o What cardiovascular investigations are required for this patient?
o If the function of the cardiovascular system has changed, why?
• Conduct a focused assessment of the renal system.
o What information from the case scenario informs the renal assessment?
o What information do you need to complete the renal assessment?
o What renal investigations are required for this patient?
o If the function of the renal system has changed, why?
• Conduct a focused assessment of the gastrointestinal system.
o What information from the case scenario informs the gastrointestinal assessment?
o What information do you need to complete the gastrointestinal assessment?
o What gastrointestinal investigations are required for this patient?
o If the function of the gastrointestinal system has changed, why?
• Conduct a focused assessment of the integumentary system.
o What information from the case scenario informs the integumentary assessment?
o What information do you need to complete the integumentary assessment?
o If the function of the integumentary system has changed, why?
• How do the patient's lifestyle factors impact the healthcare of the patient?
• How do the patient's socioeconomic factors impact the healthcare of the patient?
• How do the patient's patterns of healthcare use impact the healthcare of the patient?
Part II
In this part of the assignment, you are required to explain the pathophysiology of the patient's condition as indicated by the information in the patient handover and the results presented above.
Part III
In this part of the assignment, you are to explain one high priority intervention:
• RN actions to implement intervention
• RN actions to evaluate the intervention
• Evidence that the intervention is safe and effective
• RN actions to create patient-centred care through adherence to the social justice framework
Part IV
In this part of the assignment, you are to explain a second high priority intervention:
• RN actions to implement intervention
• RN actions to evaluate the intervention
• Evidence that the intervention is safe and effective
• RN actions to create patient-centred care through adherence to the social justice framework
Patient critical event
The RN has completed care for this patient, handed over to the oncoming shift RN (Nurse Nightly a new graduate) at 11pm, and went home. At handover the patient did not interact with the nurses, and they appeared tired due to the late hour. After the handover, Nurse Nightly went to speak with the patient but they seemed upset about being disturbed. Not wanting to upset the patient, Nurse Nightly decide to let them sleep rather than disturb them further. Overnight Nurse Nightly conducted visual observations with atorch to check the breathing rate, the lights in the cubicle were turned off. The blood pressure readings and tympanic temperature of the patient were not checked so as not to disturb the sleeping patient. The oxygen saturation probe was used twice, but the patient pulled it off their finger before a reading could be obtained. At 4am Nurse Nightly completed an observation round and found the patient, was confused as to the day, time, and location. The nurse collected a full set of vital signs at this time, but she did not calculate the ADDS score:
o Temperature = 38.6°C
o Pulse rate = 135 beats per minute, capillary refill = 5 seconds
o Respiratory rate = 30 breaths per minute
o Blood pressure = 95/60 mmHg
o Oxygen saturation = 94%
Nurse Nightly spoke with the team leader Nurse Cranky about the concerns regarding the blood pressure and oxygen saturation readings. Nurse Cranky was an RN who graduated 3 years ago, and it was her 6th night shift. Irritated by Nurse Nightly, Nurse Cranky told her to "go away and check the vital signs again in 30 minutes". Nurse Nightly felt intimidated, but repeated the vital signs again 30 minutes later.
o Temperature = 39.0°C
o Pulse rate = 140 beats per minute, capillary refill = 5 seconds
o Respiratory rate = 32 breaths per minute
o Blood pressure = 90/60 mmHg
o Oxygen saturation = 91%
The patient was now not responding to questions with inappropriate words. Nurse Nightly did not want to bother Nurse Cranky again, so she spoke with an experienced EN on duty, Nurse Hugger. The EN had a look at the patient and then fetched Nurse Cranky. Upon seeing the patient, Nurse Cranky pressed the MET call button and called the medical officer treating the patient. The patient was transferred to ICU and stayed in the hospital for 10 days longer than initially planned.
Part V
In this part of the assignment, please consider the NSQHS standards and answer the provided questions to:
• Identify how Nurse Nightly compromised the safety of the patient,
• Identify the factors that contributed to the compromised safety of the patient,
• Identify what actions were required by Nurse Nightly to ensure safe care, and
• Identify how other team members could have helped to ensure safe care.