Case Study Of Mr. B's Procedure After Sedation

The aim of this case study is to analyse and evaluate the anaesthetic and recovery care delivered to a patient undergoing an Adenotonsillectomy. To do this I will outline the process of ensuring the provision of safe and effective care for the patient, give a description of the procedure and equipment used in the anaesthetic room including the drugs used for this particular case and rationale for their use. I will also give a brief description of the surgical procedure including the anaesthetic and recovery care provided. Finally, I will summarise with an evaluation of the care that the patient received. For the purpose of this study, the patient will be referred to as ”the patient”. In doing so, the patients’ right to confidentiality will not be breached and it is also within the boundaries and guidelines set out in local trust policies G10, the Health and Care Professions Council Code of Conduct & Ethics for Students (HCPC 2012 pg 9), the Data Protection Act (1998) & the Caldecott Principles (2013).

The plaintiff in Ard v. East Jefferson General Hospital, stated on 20 May, she had rang the nurses station to inform the nursing staff that her husband was experiencing symptoms of nausea, pain, and shortness of breathe. After ringing the call button for several times her spouse received his medication. Mrs. Ard noticed that her husband continued to have difficulty breathing and ringing from side to side, the patient spouse rang the nursing station for approximately an hour and twenty-five minutes until the defendant (Ms. Florscheim) enter the room and initiated a code blue, which Mr. Ard didn’t recover. The expert witness testified that the defendant failed to provide the standard of care concerning the decease and should have read the physician’s progress notes stating patient is high risk upon assessment and observation. The defendant testified she checked on the patient but no documentation was noted. The defendant expert witness disagrees with breech of duty, which upon cross-examination the expert witness agrees with the breech of duty. The district judge, upon judgment, the defendant failed to provide the standard of care (Pozgar, 2012, p. 215-216) and award the plaintiff for damages from $50,000 to $150,000 (Pozgar, 2012, p. 242).

In the first scenario, I was in the role of the primary nurse. After receiving report, I prioritized patients based upon need and visited Mr. M first. The report mentioned he was having difficulty breathing, and seemed confused throughout the night,

Nursing assessment within 24 hours, Nutrition and hydration status, Functional status living, Social, spiritual, and cultural variables. Liza was admitted to the intensive care right away which wasn’t appropriate. The first step in the evaluation of a patient presenting with syncope consists of obtaining a detailed history and conducting a physical examination including blood pressure (BP) measurements and standard ECG. In this case, the nursing staff started began performing nervous system checks after 18 hours of her admission which is in my opinion was not appropriate because that should have been done right away after her arrival to the emergency room and after doing these evaluations, they should’ve decided on whether she was supposed to be admitted to intensive care or not. Also, the results of these tests would help them determine if a CT scan was needed and if needed, it should’ve been right away. In my opinion, Liza’s admission processes were not handled properly by the nursing staff at the hospital and her treatment was delayed. If all the processes were done on time and all the tests were done right away, her condition would not have worsened and she could have been started on anticoagulants for cerebral infarction. Patients have a better chance of survival and recovery if these drugs are taken within 12 hours of the incident. Most patients are administered these drugs within 90 minutes of hospital arrival.

As teams of two we were requested to complete a number of tests on a client my clients name in this scenario will be called Mrs. R (NMC 2015) patients name will remain confidential as detailed in nmc code. she was a female 50years old who came into the general practitioner with a complaint of not feeling very well, I and my team member and fellow student nurse was given the job of working together to assess Mrs. R’s vital signs

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

I returned to the recovery ward, my patient was still hypertensive and tachycardic and I felt by assessing her non-verbal signals of communication that she was still in great discomfort. After 15 minutes of no improvement I returned to theatre to see the anaesthetist, I explained that I was not happy with the patient’s level of pain and requested that he come to the recovery ward to assess the patient. He reluctantly came to the recovery ward and after spending a few minutes assessing the patient agreed that she was in an unacceptable level of pain and prescribed a further 5mg of morphine which I duly gave to the patient in 2.5mg increments. After this the patients heart rate and blood pressure decreased to pre operative levels, she seemed to be more relaxed and eventually fell asleep. After a further period of time spent continually reassessing the patient and when I was satisfied she was comfortable and haemodynamically stable I discharged the patient back to the ward.

A policy for conscious sedation was in place and not followed by staff. As all staff had been trained in the procedure, completed the appropriate modules, and

To do so, I am going to use the fishbone diagram to categorize the causative factors (Potter & Perry, 2008).   For patient characteristics, Mr. B was a 67 year old patient with routine use of oxycodone to treat chronic pain.  Because of his routine use of oxycodone, he may need a different dose to get to a sedated level than other people who are not on any medication.  Next is the task factors, the hospital had a policy which requires that anyone who are treated with moderate sedation or analgesia have to be put on continuous blood pressure, ECG, and pulse oximeter monitoring until the procedure is done and patient is in stable condition.  Mr. B was not being monitored accordingly during the sedation process.  Another task factors is that all staffs must first complete a training module on sedation before performing the task.  Individual staff is a factor too, Nurse J had completed the training module on sedation, he had an ACLS certification as well as experience working as a critical care nurse.  Team factors include communication between staffs; an example would be the LPN not informing Nurse J or Dr. T when the alarm went off the first time, it showed that Mr. B had low oxygen saturation.  Work environment factors included the staffing in the ER, the equipments they had, and the level of experience of the staffs.  According to the scenario, additional staffs were available for back up support and all the equipment needed

The patient, her family, and the attendee were not included in the interprofessional collaborative team during the situation. Had the nurse communicated the blood pressure findings to the patient, it might

In April 2012, Mr. Hammett’s death was ruled to be human errors that individually would have been unlikely to harm him but proved collectively to be fatal. Mr. Hammett surgery was at at private hospital that did not have any after hours medical cover. During the procedure his oxygen saturation levels were almost perfect, maintaining it at 99%. Somehow during or after being transferred to Post Anaesthetic Care Unit (PACU) his oxygen saturation levels fell to 64%. The anaesthetist assumed that it was caused by an obstructed airway and discharged the patient to the ward; he did not look for anything further to be wrong with the patient. Mr. Hammett complained continously to the RN of high levels of pain; the RN ignored him and referred to him as a “wimp” when switching shifts. Although Mr. Hammett was on a Gemstar pump, which recorded him pressing

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

a. The LPN was engaged in caring for the emergency transport patient along with the RN and was also in the process of discharging the other two patients. 3. Why did the LPN not notify the RN of the alarm and reading? a. With the information provided, it appears that the LPN was distracted as well as did not follow her scope of practice.

assess Mr. B’s respiratory states while Nurse J. and Dr. T finished the sedation and reduction

Another day of my clinical placement 420 in orthopaedic unit began on July 4, 2015. I received my patient and started to research a patient history and medications. At 0700 a shift report started, I received information that my patient had fall at night shift without witnesses. By the policy of Providence Healthcare a patient who had fall without witnesses should be automatically monitored for head injury therefore, a Glasgow Coma Scale was initiated by previous nurse: every 15 minutes, then every hour, every two hours, and every 4 hours. This scale is to check and monitor level of consciousness which possibly may decline after head injury. At this day we had a student as a "nurse in charge", she volunteered to come with me to patient room and to supervise my work. For this particular patient close monitoring of vital signs and neurologic assessment required. I explained to the patient the purpose of frequent health assessment and started to work. Close patient monitoring in addition to all daily routine activities was challenging to me because I never had a patient with this diagnosis. Despite my explanation of the purpose of frequent assessments patient stated that "I am fine, do not feel any discomfort, there is no need for that". While assessing patient she keep asking a lot of questions such as why so many time why do I need to drink more than one mouthful of water with my tablets, what these tablets for, why do I need to wait few minutes after