Identify the evidence for the safe administration of all of the medications, intravenous fluids and blood products (as applicable) that have been ordered for this patient to support appropriate nursing care of the patient.
Identify the systematic health assessment framework you would use to assess this patient. Apply this framework to your chosen case to identify the information that is present in the case and the assessments that you would need to perform to complete your assessment.
Marking rubric states: Systematic health assessment framework applied to identify all relevant information provided in the case and addresses all relevant information that needs to be assessed.
I WOULD LIKE TO USE THE HIRAID FRAMEWORK: http://www.aenj.com.au/article/S1574-6267(15)00026-9/fulltext#sec0060
NOTES: Identify information in the case – what assessments would you do?
Observations – Respiratory rate we have the information, we would need to ausculate the chest ect ect
What assessments are necessary and why?
Question 2.
Identify the evidence for the safe administration of all of the medications, intravenous fluids and blood products (as applicable) that have been ordered for this patient to support appropriate nursing care of the patient.
Marking rubric states: Best available evidence regarding safe administration of all medications, intravenous fluids and blood products relevant to case has been identified
NOTE: Jessica has a penicilin allergy, JESSICAS MEDICATIONS:
PARTT 1: THESE WERE CHARTED AND USED IN THE EMERGENCY DEPARTMENT
salbutamol nebuliser 5mg,
IV 100mg hydrocotisone,
Ipratropium Bromide 500mcg nebuliser.
PART 2: THESE WERE USED TO INTUBATED JESSICAAND INSERT CVC IN THE INTENSIVE CARE UNIT
1000MLS of normal saline to be given over 8 hours,
100mls of normal saline with 100mg of morphine as additive to be given 1-2mls per hour,
propofal 600mg in 60mls to be given as per NSW Health hospital protocol,
hartmanns 1000mls over 12 hours.
NOTES: BRIEFLY mention the 5 rights of medication administration
Look at evidence of medications – why would this patient benefit from using these medications?
Evidence that supports why they were charted? Were they appropriate – why or whynot?
Is the medication appropriate for the condition? Does your patient have any contraindications? Is the dose therapeutic? Is there a more appropriate medication? Do you need to perform any tests or observations before, during or after?
Question 3.
Identify the legal, ethical and professional issues with this case and discuss the nurse’s role in addressing these issues.
Marking rubric states: Identifies all relevant legal, ethical and professional issues involved in the case chosen
Discussion includes the role of the nurse in addressing the issues with clear, detailed and insightful examples
NOTE added extra to the case scenarion: In the video we seen in class, the nurse provides confidential information about the patient Jessica to her next door neighbour when he comes to visit her in the intensive care unit. The nurse did not confirm who the person was, or if he was next of kin, prior to providing Jessica’s medical information, the nurse assumed it was a relative/family member.
NOTES:
Law at state if – breach of privacy for Jessica?? state or federal law – which law, what part of the law, what legal impacts the cases is going to have, this of ethical
professional issues – standards for registered nurses, code of conduct for registered nurses
what nurse can do to ensure this doesnt happen again?
3-5 specifc issues need to be discussed.
Part 1
Jessica is a 27 year old female presenting with an acute onset of shortness of breath. She presented to your ED two hours ago with tachypnoea, audible wheezing and she was very distressed.
Jessica is a university student studying nursing. She has been using her Ventolin Inhaler several times a day for the past three days, according to her next door neighbour. She has been very stressed about an assignment she has due tomorrow and she has not been sleeping or eating well as a result. Jessica was intubated with asthma twice in the past. Her neighbour mentioned Jessica was reluctant to come to hospital.
Despite being prescribed a preventative inhaler, Jessica confesses she hardly even knows where it is. She is speaking to you in 4-5 words at a time and looks fatigued and distressed despite having three doses of nebulised salbutamol since arriving. She is still wearing her clothes that she came in with. She is beginning to feel ‘jittery’ and nauseous.
You need to assume care of Jessica as a multi-vehicle motor vehicle accident has just occurred down town and the other ED nursing staff are required to stabilise the people involved as they are arriving in ED.
EXTRA NOTES: JESSICA IS ADMINISTERED SALBUTAMOL NEBULISER WITHOUT GOOD EFFECT, SHE IS THEN STARTED ON NON-INVASIVE VENTILATION PRIOR TO BEING TRANSFERED TO THE INTENSIVE CARE SECTION FOR INTUBATION.
JESSICA IS INTUBATED AND HAD A CVC INSERTED USING PROPOFOL AND MORPHINE (THESE DRUGS TAKE A WHILE TO LEAVE THE BODY AND REQUIRE MONITORING).
JESSICAS NEIGHBOUR COMES TO VISIT HER IN HOSPITAL AND THE NURSE PROVIDES ALL JESSICAS DETAILS TO HIM, AS SHE THOUGHT HE WAS A FAMILY MEMBER.
Part 2
Jessica is a 27 year old female who presented with an acute onset of shortness of breath. She was diagnosed with severe asthma. Her symptoms worsened in ED to the point that she was intubated and admitted to the Intensive Care Unit.
Jessica is largely unaware of the events of the last 4 days. She has been heavily sedated for two days and then moderately sedated until last night. She had a central venous catheter (CVC) inserted in her left subclavian (SC) vein which has remained functional since insertion. She had an arterial line in the right radial artery but this became non-functional this morning so it was removed.
The most recent Arterial Blood Gas (ABG) indicates Jessica has improved substantially since her intubation and her chest x-ray is much improved. She is likely to be extubated this morning once reviewed by the Intensive Care Specialist (Doctor). Jessica’s sedation has been weaned overnight so she is now completely awake and aware of what is happening to her.
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