NURS13141 - Acute Alterations in Health in Complex Care Environments Assignment

Assignment Task

Aim

This assessment aims to demonstrate critical thinking and clinical reasoning in the care of a person with an acute alteration in health presenting to the Emergency Department (ED). The information required to undertake this assessment is covered in Modules 1- 4.

Patient presentation to ED (Emergency Department) of Mrs Alison Smithson (Scenario 1)

Monday morning 0930 hours

Mrs Alison Smithson is a 79-year-old female who lives alone in a small flat close to Caring Hospital, where you are currently working as a graduate nurse in the Emergency Department (ED). Alison was bought to the ED via ambulance following a fall at her home. The ambulance was contacted by the neighbour Bill, as he could not get Alison to answer the door.

The ambulance officers found Alison lying on the floor near the toilet, unable to move due to significant pain in her left hip and ribs. She seemed mildly dazed, had a small graze on her left forehead, and was noted to be incontinent of urine. Her observations at the scene indicated that she was tachypneic and hypothermic.

The ambulance officers insert an 16g Intravenous (IV) cannula and commence an IV infusion of Normal Saline (NS) 1 litre running at 82 mls/hour. They administer 2.5mg of IV morphine prior to transporting her to the hospital. She presents with a fractured left neck of femur (NOF) and possible fractured ribs, confusion and a possible urinary tract infection. The ambulance officers inform you that the neighbour stated that Alison was normally fit and active, had no history of dementia, and was currently taking Metoprolol 50mg daily. She has no allergies, and her vaccinations are all up to date. Alison is divorced and lists her next of kin as her brother Luke who lives interstate. Based on the information provided, Allison was triaged as a category three before being moved to a cubicle for further assessment and management.

ED 1000 hours

The ED Registrar has reviewed Alison and ordered the following: Bloods for Full Blood Count (FBC), Urea and Electrolytes (U&Es), and Liver Function Tests (LFT). Bedside testing for lactate, venous blood gases, and Troponin, IV Paracetamol 1 gram, X-ray of Left hip, pelvis and chest, and Computed Tomography (CT) head. She is to be seen by the orthopaedic team shortly for review.

Your buddy Registered Nurse (RN) Troy asks you to begin the further assessments required for Alison and informs you that he will be with you to assist once he finishes with another patient. You then introduce yourself to Alison and explain to her the nursing activities that you will be performing. You note that she seems slightly confused as to her surroundings. You undertake a set of observations and record the following: Respiratory rate (RR): 28 per minute, SpO2: 93% on room air, Blood Pressure (BP):116/88mmHg, Pulse Rate (PR): 72 per minute, strong and regular, Temperature: 35.9'C, Glasgow Coma Score (GCS): 14, Pain score, using numeric scale as 6/10, with complaints of pain on her left side in the lower thoracic area.

Shortly afterwards, another RN Sabina arrives to assist you as Troy has been called away to see another patient. Sabina asks for a full handover as she has just come to help from another area and has no information regarding Alison’s situation. Sabina is interested in educating and supporting new graduate nurses, so she also asks you to explain the rationale for the interventions that have been implemented so far.

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