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Description My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to

A1. Errors or Hazards Not only did insufficient staffing contribute to the causes of this particular event, but human error also played a significant role. When Mr. B arrived at the ED, he was hyperventilating. His leg “appeared shortened.” He had edema in his calf, ecchymosis, limited ROM, and he rated his pain at a ten out of ten. Mr. B also had a history of prostate cancer, impaired glucose tolerance, elevated cholesterol and lipids, and chronic pain. He was admitted to the ED with a plan to relocate his hip. Dr. T ordered diazepam 5.0 mg to be administered through IVP and then just five minutes later ordered 2.0 mg hydromorphone to be administered because it appeared that the diazepam was not having the intended sedating effect. Again, just five minutes later, Dr. T was still not satisfied with the level of sedation and instructed the nurse to

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.

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

Look Back 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

The importance of assessing for delirium cannot be stressed enough. Dr Tsuei preformed a study that demonstrated frequent assessment, categorized as every four awake hours, increased the detection of delirium by 55% compared to a once daily delirium assessment. This indicates that once daily assessment for delirium is not sufficient and no assessment is severely deficient. In assessing for delirium every four awake hours, we increase the reporting and thus treatment of this fatal illness. Though there is no specific treatment for delirium at this time certain medication recommendations have been made as well as improving nursing interventions to decrease delirium.

Enhanced assessment and nursing implementations to better prevent and detect ICU delirium will bring improved outcomes for this particular patient population. There are many ways to assess for ICU delirium. Two of the most reliable and easiest methods are basic observations from the bedside nurse and The Confusion Assessment Method (CAM). The CAM includes nine different criteria for delirium (1) acute onset and fluctuation, (2) inattention, (3) disorganized thinking, (4) altered level of consciousness, (5) disorientation, (6) memory impairment, (7) perceptual disturbances, (8) psychomotor agitation or retardation, and (9) altered sleep-wake cycle. A delirium diagnosis is given when criteria one and two and either three or four are present. The second assessment tool for delirium detection is made from nursing observations. The nurse observes the patient throughout their

On august 13, 2016 I was assigned to follow one of the ICU Nurse. It was a very calm day. She had two patient one was more critical than the other. Both patients were on the ventilator because they had to be intubated the night before.

Ms. Maness is a 45 year old female who presented to the ED with an alleged overdose on 3 pills of Keppra and 3 pills of Librium in a attempt to harm self. Ms. Maness denies suicidal ideations, homicidal ideations, and symptoms of psychosis. Ms. Maness reports a history of Alcohol abuse and recently was 3 days sober, however last night relapsed after conflict with hr boyfriend. Ms. Maness does not appears to be responding to any internal stimuli.

If I was a new administrator at Jamestown Medical Center and I received a phone call from the nurse manager stating that she suspects Dr. Smith being intoxicated, the first thing I would do is ask the nurse to elaborate for me on what she saw. After speaking with the nurse, I will then go to the emergency room department and make my own observations. If I notice any changes in Smith’s speech, behavior, appearance or even smell alcohol, I would quickly pull the physician outside in a private location to address the situation. After speaking with the physician, I would then send him home and see which physician is on-call to take over his shift. At the moment I will document what had occurred and put it aside until his next shift. Once the doctor

The elderly patients in the Intensive Care Unit (ICU) who have been diagnosed with delirium have unique characteristics (Britton, & Russell, 2003). Some of the

Mrs. Foster is a 81 year old female who presented ED a history of dementia. Per documentation daughter reports this has been her mother's baseline for the past week. At the time of the assessment Mrs. Foster denies suicidal ideation, homicidal ideation, and symptoms of psychosis. During the assessment Mrs.

On scene vitals were check in office, P/t BP was in normal range 124/88, but pulse was 112 (strong and rapid). P/t said she does not partake in any forms of illegal substances or alcohol products. P/t was told five times that it would be in her best interest if she go to the hospital to get checked out. P/t said she will scheldule an appointment with a doctor's office in the morning

Introduction Delirium in hospitalized older adults is one of the most difficult presentations for nurses to recognize. There are many reasons that delirium is difficult to recognize, some include but are not limited to: the amount of medications that older adults are prescribed, the effects of anesthesia on the older adult, the nurses lack of knowledge regarding atypical presentations, and critical older adults may have difficulty expressing themselves and their needs. Delirium may be misdiagnosed due to lack of assessment technique or lack of knowledge by the clinical staff of cognitive illnesses. There are many factors that can put an older adult at risk for delirium, which will be discussed later in the paper. Neurological changes that can have an acute change may include behavioral changes, perceptual changes, emotional changes, or psychomotor changes. Delirium also puts the patient at risk for longer hospital stays, and due to the length of stay, the patients ' are at higher risk for falls, skin breakdown, and urinary tract infections (SITE: MEDSURG, 318)The purpose of the paper is to look into new research and evidence that effectively helps nurses recognize delirium in older adults, as well as ways to manage delirium.

I choice to use the Seven Step Model of a Decision-Making Model for Resolving Ethical Issues in order to define what is ethical in this case study. 1. Gather the Facts Joanna is an experienced nurse taking care of Mrs. Kelly, who was Joanna’s patient many times in the past for her