Ista Fascicular Block Case

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

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.

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

The patient complained of right lower quadrant pain and of feeling faint. Dr. O'Donnel documented a chief complaint, a brief history of present illness, and a systemic review of the gastrointestinal system and respiratory system. Dr. O'Donnel also documented a complete examination of all body systems, which included all required elements. Medical decision making was of moderate complexity.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

Vital observations were carried out efficiently, they were recorded every 15 minutes and a cardiac monitor was attached to continuously monitor for any deterioration. As a student nurse I assisted by recording vital observations using NEWS and assessing consciousness by using the Glasgow coma scale to ensure there were no signs of brain trauma (Le Roux, Levine and Kofke, 2013). In line with the NMC, my mentor supervised and countersigned my observations (NMC, 2011b). I promoted good patient safety as deterioration would be recognised early and appropriate care provided. Throughout the treatment process I witnessed and provided person centred care. Nursing and medical staff continuously checked patient comfort and obtained consent for treatment being provided.

Usually, we start the observations around 22:00, reporting any NEWS score over 3 or anything untoward to the the Staff Nurse who will inform a doctor who may order an ECG, which I would perform and report straight back to him/her. This is an example of how communication and co-operation is so important to working in partnership. Any missing ‘cog’ in a machine could spell disaster, especially in the care industry.

Ms. Sunshine immediately was placed on oxygen, sitting upright, an IV infusing, had blood work sent for numerous labs, including cardiac markers, had a chest x-ray and an electrocardiogram (EKG) performed. A clinical nurse leader is able to teach patients and patients regarding health promotion, disease prevention, or disease management (American Association of Colleges of Nursing, 2011). It is important to understand the pathophysiology behind disease processes in order to help facilitate better outcomes for Ms. Sunshine.

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is

Some hospitals almost never ordered an ECG, and others almost 100 percent of the time ordered an ECG,” in average it was

The patient is an 81-year-old gentleman who is admitted after a fall at home. He patient feels that the fall was mostly mechanical. The patient was having left-sided weakness. He denies loss of consciousness, denies any other reasons for the fall, but does admit to feeling weaker and his left side feeling heavier. he denies any chest pain or significant short of breath. He has had a an upper respiratory infection but no fever but with some chills and several episodes of watery diarrhea. His medical history significant for CVA in 2011, coronary artery disease, mitral valve repair, atrial fibrillation on Coumadin and is also has a pacemaker in place. Complete work up was done. Cardiology was uncomfortable that there was no true syncopal

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.