Reference no: EM133689822

Assignment:

Situation - You are the trauma nurse working in the emergency department (ED) of a busy primary care facility. The ED is somewhat busy, as usual, but not unmanageable. You receive a call from the paramedics that they are in route to your facility with the victim of gunshot wounds to the chest and abdomen.

Background - The paramedics call in to tell you they are running hot and have started two large-bore IV lines with lactated Ringer's infusing wide open and oxygen by nonrebreather mask at 15 L/min. The paramedics give a brief history of a 25-year-old male that has a sucking chest wound on the right and a wound in the left upper quadrant (LUQ) of the abdomen. Vital signs in the field are BP 80/36 (51), HR - 150, and RR - 36. The patient is diaphoretic, very pale, and confused. The estimated time of arrival is 4 minutes.

Assessment - On arrival, you note that the patient is cyanotic and in severe respiratory distress. Chest wall movement is greater on the left than it is on the right. You also note that the trachea is deviating to the left. When he is transferred to the trauma stretcher, you notice that there is an occlusive dressing over the sucking wound on his right chest. It is taped down on three sides. There is swelling in the RUQ of the abdomen, and you note that the dressing the paramedics applied is saturated with blood. Vital signs are as follows: HR - 150, BP - 80/50 (60), RR - 24 and shallow, T - 96.5 ? (35.8?) O2 saturation - 85% on the 100% nonrebreather mask.

Points to assess: Is this Acute or Chronic? Is the patient Unstable or Stable? Is this Urgent or Nonurgent?

Recommendation(s) -

1. What are the risk factors for this patient, and do they contribute to the current primary problem?
2. What assessment(s) (expected finding) should be your focus? (Hint: Identify the relevant information first to determine what is most important.)?What signs and symptoms are commonly seen with this condition?
3. What data should you analyze (laboratory and diagnostic procedures) and report to the health care provider? (Hint: Think about priority collaborative problems that support and contradict the information presented in this situation.)?What lab values may be abnormal?
4. What would your plan (nursing care) and recommendation(s) be to the health care provider? (Hint: Consider all possibilities and determine their urgency and risk for this client.)
5. What intervention(s) (therapeutic procedures and/or medications) would be your priority with this patient? (Hint: Determine the desired outcome first to decide which interventions are appropriate and those that should be avoided.)?Which intervention would be best for this patient?
6. What data/clinical information would you evaluate to support the plan to improve the patient's outcome? (Hint: Think about signs that would indicate an improvement, decline, or unchanged client condition.)?What changes to the patient's condition would I expect to see happen or have happened?
7. What interprofessional care would be involved in the care of the patient? (Other disciplines - RT, ECG, social worker, etc.)
8. What patient education would be important for this patient?
9. Are there any specific safety considerations that should be included in your care?
10. What may be inserted at the bedside in a patient with a sucking chest wound?
11. Why may this patient be cyanotic and in severe respiratory distress?
12. What is the ABCDE of trauma assessment?
13. What are the ways of maintaining patient and staff safety in the emergency department?
14. What are some of the most common patient safety issues?
15. Who sets the metrics that establishes a metric based on the ED length of stay (LOS) that hospitals are required to admit?
16. What are the most common reasons that people seek ED care?
17. What are the common procedures that are done in the ED?
18. What is the three-tiered triage system with example of patient for each tier?
19. What is the Emergency Severity Index?
20. What are the four levels of trauma centers and the functions of each trauma center?
21. In this patient, what would be the mechanism of injury?
22. What does AVPU stand for?
23. What is the worst possible/most likely complication(s) to anticipate based on the primary problem (to prevent death)?
24. What nursing assessments will identify this complication EARLY if it develops??What nursing interventions will you initiate if this complication develops?