Reference no: EM133507218

Question

Mr. Evans, 40 years old, was admitted to the hospital's medical-surgical unit from the emergency department with a diagnosis of acute abdomen. He had a 20-year history of Crohn's disease and was on multiple medications including the new biological agent Etanercept, 50 mg, subcutaneously every week. His last dose was 4 days ago. He was (NPO), receiving total parenteral nutrition was through a triple-lumen central venous catheter line. His other medications were changed to (IV) push every 6 hours.

Over the next 3 days, his condition worsened. He was in severe pain and needed more analgesics. One evening at 9 p.m., it was discovered that his central venous catheter line was out. The assigned RN notified the physician, who stated that a surgeon would come in the morning to replace it. The nurse failed to ask the physician what to do about the IV steroids, antibiotics, and fluid replacement; the client was still NPO and etanercept. The am nurse noted he had no urine output since the night before. She documented this but forgot to report this information to the nurse assuming care responsibilities on the day shift.

The patient's physician made rounds at 9 a.m. The nurse for Mr. Evans did not tell him that the patient had not voided since 11 p.m., did not request orders for alternative delivery of the steroids and antibiotics, and did not ask about administering the etanercept. At 5 p.m. that evening, while Mr. Evans was having a computed tomography scan, his blood pressure dropped to 70 mm Hg, and because no one was in the scan room with him, he coded. He was transported to the ICU and intubated. He developed severe sepsis and acute respiratory distress syndrome.

1. Describe all the problems you can find with the nursing care in this case as it relates to the patient outcome.

2. Evaluate nursing responsibilities in reporting information.

3. If you worked in risk management, evaluate how you would analyze this situation with the nurse manager and the staff and the steps you would take to come to a reasonable conclusion of what caused the untoward outcome. Pay particular attention to this question.

4. What would your corrective actions for all those involved in this case include and why? Include what your plan for prevention of this type of scenario would look like.