Intro to Acute Care Case Study Scenario:

Intro to Acute Care Case Study Scenario: End of shift report on one of your four patients: A 64-year-old male admitted four days ago after a MVC (motor vehicle crash). Injuries incurred were left femur fracture and left rib fractures. The patient has been on room air with sats 96%, surgery for open reduction and internal fixation of the femur completed three days ago. VSS overnight and received Percocet once at midnight. Wife is at bedside and has been here most of the night. She is a bit anxious and needy. Orders include: Meds: Percocet 2 tabs q 4 hours prn for pain control. Metoprolol 25 mg po daily. Activity as tolerated with non-weight bearing on the affected leg. Physical and occupational therapy consults. Diabetic diet 1. What more would you have wanted to know from the report? How will you access this information? 2. What assessments will be priority when you meet the patient? 3. What type of support will you provide to the patient’s wife? ______________________________________________________________________________ You learn that the patient has co-morbities of mitral valve replacement, HTN, COPD, anxiety, diabetes type 2, and obesity. PTA home meds include glipizide, plavix, lisinopril, and an albuterol inhaler. Upon entering the room, the patient is exhibiting shortness of breath. The wife reports that her husband has been having a hard time breathing for ‘quite awhile’. As you introduce yourself to them, you know your initial plan must change. 4. What assessments will you plan to complete now? 5. What are three interventions you would complete? Your initial assessment findings include: 02 saturation of 87% on RA, RR – 33, BR – 109/68, HR – 90, Temp – 98o F and chest pain at 4/10. You sit the patient up, apply oxygen when the increased work of breathing (WOB) and 02 saturations continue in the upper 80s. The patient does not improve. 6. What is your next step? You receive the following orders from the provider: 02 to maintain sats >92% SL every 5 min x3 for chest pain Stat EKG The patient’s wife is becoming quite anxious and asking many questions about what is happening. You are having difficulty caring for the patient with her constant interruptions. You also realize an hour has passed and you have not seen your other three patients. 7. How will you proceed with these interventions and look out for the care of your other patients? The patient states his chest pain is worse at 6/10, RR – 34, HR – 100, BP – 105/65, 02 sat – 85% Results of the EKG shows no acute changes. Then the patient decompensates further and becomes unresponsive. 8. What is your next action? ______________________________________________________________________________ The Rapid Response Team (RRT) arrives and the scene becomes quite chaotic. Everyone asks questions and is moving into their roles. 9. What is your role as the primary nurse on the team? 10. Who are the members of this team and what are their roles? The patient stops breathing, and there is no pulse. CPR is started by the team. The patient’s wife becomes increasingly verbal and anxiously asks “What is happening?” “How did this happen?” “He is young, he will be fine right?” She keeps moving toward her husband moving between team members to get to the bedside. Two of his adult children arrive and are waiting in the hallway, looking in the doorway. 11. What should be done to support the family members while still allowing for safe and competent care of the patient? After 25 minutes of CPR, the code is called and the patient does not survive. The provider tells the family that there is nothing more that they can do. 12. What will you say to the family? 13. What stage of grief do you expect them to be in? 14. What do you think caused this patient’s demise? Consider his clinical situation and co-morbidities? SCIENCE HEALTH SCIENCE NURSING NURS 2021

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