Time: Upon arrival to ED Setting: Emergency Department Part 1-…

Question Time: Upon arrival to ED Setting: Emergency Department Part 1-… Time: Upon arrival to EDSetting: Emergency Department Part 1- CardiacShift Report (SBAR)S: Carl Shapiro is a 54- year-old Caucasian male who was brought to the ED by a female co-worker today for c/o chest pain and diaphoresis. He states the chest pain started this morning and has been unrelieved after taking Tums. He notes he has had similar pain in the past that has improved with rest. He is here on business and lives in Ohio.B: He has a past medical history of hypertension. He states that he takes a “water pill” for his blood pressure (he is not sure of the medication name). No significant past surgical history. Smokes less than ½ pack of cigarettes per day and reports occasional alcohol use. He states he has been married for 5 years and has a very stressful life secondary to his job. He has been trying to exercise and lose weight but admits it is very hard when he travels. A: Vital signs in triage: BP 155/90, RR 24, HR 110, SpO2 93% RA, T 98.5F, weight 252 lbs. Saline lock in place to R AC.R: Please perform an appropriate focused cardiac assessment on this patient. Dr. Williams, MD has seen the patient and placed initial orders.  Vitals that students take: RR: 26HR: 120BP: 158/92SpO2: 90% RATemp: 98.4FPain: 8/10 and he is sweatingPart 1  1.   Pt states: “The pain is like a constant tight belt around my chest. It does not radiate anywhere. I’ve had pain like this before, but normally it goes away when I take Tums. Just walking from the hotel to the car made the pain worse.” Based off what Mr. Shaprio stated, write out how you would chart his pain using PQRST (P= palliative/provoking, Q=quality, R=radiation/region, S=severity, T=time). 2.   What system would you focus assessment on based off his history and complaint? Describe in detail everything you would assess within that system. Example: Auscultate (anterior and posterior) lungs for breath sounds and adventitious sounds.   3.   Based off your assessment and patient complaint, what do you think is our patient clinical problem? 4.   What medication would you give for his chest pain? What is your rationale? 5.   After recognizing your medication of choice, perform AIDET (see example at end of worksheet) to your patient. In detail, describe how would you educate them on the necessity of this medication. Part 2. Respiratory Setting: Emergency Room Time: Immediate upon patient presenting to the EDShift Report (SBAR)S: Jennifer Hoffman is a 33-year old female brought to the Emergency Department by ambulance. She has a history of asthma (since childhood) with multiple emergency visits within the last year. She is in acute respiratory distress.B: She has a history of asthma (since childhood). She reports having seasonal hay fever and frequent upper respiratory infections. Ms. Hoffman has been to the ED several times in the past year and most recently diagnosed with a respiratory infection. Never married. No kids. She is a nonsmoker but does drink alcohol occasionally (1-3 drinks/week). A: She appears to be in severe respiratory distress, struggling to breathe. She is unable to speak other than simple one-word statements. She is extremely anxious, profusely diaphoretic, and is seen leaning over using accessory muscles to breath. There are no family members with her. R: Please perform VS and an appropriate focused respiratory assessment on this patient. MD has seen the patient and placed initial orders in the electronic health record. The patient needs to be put on the cardiac monitor, the labs have been drawn, X-Ray done, and the IV has been started in right arm.Initial Vitals:RR: 24HR: 118BP: 140/90SpO2: 85% on RA Temp: 98.9 FPain: 4/10 (from coughing) Part 21.   Based off what was received in report, what are your initial concerns?  2.   What about her vital signs are concerning to you? Give your rationale as to why they are out of normal range.  3.   What systems would you focus assessment on based off her history and complaint? Describe in detail everything you would assess within that system. Be sure to list what abnormal findings you would expect for this patient to have. Example: Auscultate (anterior and posterior) lungs for breath sounds and adventitious sounds.      4.    Describe in detail what interventions you would implement and your order of priorities. 5.   What medication would be your first choice to help correct her distress. Rationale? Explain how you would give that medication.   6.   How would you evaluate that your interventions had a positive outcome? 7.   Write 2 nursing diagnosis related to this patient.    Part 3- NeuroTime: Upon arrival to EDSetting: Emergency Department. EMT is giving you report.  S: William Edmondson is an 85-year old male who presented to the emergency department via EMS approximately 5 minutes ago after experiencing Right sided weakness and garbled speech.B: He has past medical history of hypertension, diabetes type II, hyperlipidemia, and coronary artery disease, No significant past surgical history. Allergic to Codeine. Smokes 1 pack of cigarettes per day. Reports occasional alcohol use. He is married to his wife of 55 years. He is a retired police officer. Stated he hasn’t had much of an appetite lately, he worried about his wife who is battling cancer. A: Vital signs take by EMS: BP 168/90, RR 24, HR 95, SpO2 98% RA, T 98.5F. Saline lock in place to R AC. C/O Numbness in the face, arm, and leg, especially on right side of this body. Garbled speech, decreased mobility, and an unsteady gait. Pupils: R > L. EMT asked him to raise both arms but he could only lift his right arm halfway. Extremities cool to touch, decreased sensation, no signs of breakdown. Reports visual disturbance. R: Dr. Amin has seen the patient and placed initial orders including a CT Head w/o contrast and NPO. Labs, EKG, and X-ray completed. Vital signs taken by the Students in ED:RR: 26HR: 92BP: 172/98SpO2: 98% RATemp: 98.4FPain: 3/10 (HA)BG- 202Pt states with a slurr: “I cccan bbbarely lift my aarm. It feels nnnuuummbb, I cant ffeel you ttttouching me. I am sooooooo weakkkkk. I amm Willliam Eeeedmondson and I’m atttt the hossspital. I think it hassss to be abbbbout 10pm bbby now right.”   Part 31.   Based off what was received in report, list your major initial concerns. Describe in detail what you think Mr. Edmondson could be suffering from. 2.   What systems would you focus assessment on based off his history and complaint? Describe in detail everything you would assess within that system. Be sure to list what abnormal findings you would expect for this patient to have. Example: Auscultate (anterior and posterior) lungs for breath sounds and adventitious sounds.       3.   Based off report, describe what you think he is at risk for. Rationale? 4.   Knowing he is NPO and has a blood sugar of 202, would it be appropriate to treat this? Why or why not? Rationale.  5.   Describe the 6 P’s. Why would it be important to assess this on this patient?   6.   Write 2 nursing diagnosis related to this patient.   Health Science Science Nursing NURSING NUR 215 Share QuestionEmailCopy link Comments (0)