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BEN Part 1

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sam mcadventurer

on 13 May 2015

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Transcript of BEN Part 1

Patient Introduction
Airway
Breathing
Circulation
Disability
Exposure
What information will the emergency team need to prioritise Bens care?
Glasgow Coma Score of 15
Ben complains of severe pain in his left leg
He is feeling nauseated
His left leg is swollen and discoloured
The orthopaedic consultant has confirmed that Ben has a closed fracture of his tibia and fibula which requires surgical interventions
Reference:
NSW Health.(2009). Detect: When to worry. Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp


Explain the nursing assessments that you will undertake.
Primary Survey
Disability – Level Of Consciousness (Glasgow Coma Scale and AVPU); Pupil response; Pain – Numerical scale and PQRST (provokes/palliates, quality, radiates, severity, time)

Exposure – limb observations: CWMS (colour, warmth, movement, sensation) and swelling, deformity, bleeding, and temperature of the limb
Primary survey
– identify and manage immediate threat
Global assessment

ABCDE method
Airway – patient is talking in a normal voice

Breathing – respiratory rate, chest symmetry, chest injury

Circulation – pulse and BP, capillary refill, diaphoresis, peripheral pulses; haematoma, oedema

Secondary survey
- identify the threats that could harm or disable the patient later
Complete health history
AMPLE – Allergies, medication, past medical history, last meal taken, clinical events resulting to the incident
Comprehensive head to toe exam
Diagnostic and laboratory testing
What is the nurses' role in obtaining consent of a 15 year old minor?
Consent-
'autonomous authorization of a medical intervention..by individual patients' (Beauchamp & Faden, 2004)

Section 174 of the Children and Young Persons (Care and Protection) Act 1998
- no consent if the medical practitioner is of the opinion that it is necessary to carry out the treatment on the child or young person in order to save their life or to prevent serious damage to his or her health
Reference:
Kerridge, I., Lowe, L., & Stewart, C. (2011).
Ethics and law for the health professions
(3rd Ed). Riverwood, Ligare Pty Ltd. Retrieved from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf

Roles of the nurse:

Ensure that the consent has been obtained
Should be aware of the requirements of a valid consent and who may provide it
consent form are completed by the treating doctor
if the patient asks question regarding the procedure, nurse must inform the treating doctor of the patient's concerns and document
Discuss methods of
handover that may be suitable for Bens care
People who need to have treatment within 30 minutes are categorised as having a potentially life-threatening condition. People in this group suffer from severe illness, bleed heavily from cuts,
have major fractures
, or be dehydrated.
Triage Category 3
Reference:
NSW Health.(2009). Detect: When to worry. Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

Reference:
NSW Health.(2009).
Detect: When to worry
. Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

Reference:
NSW Health.(2009).
Detect: When to worry.
Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

Reference:
NSW Health.(2009).
Detect: When to worry
. Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

Reference:
NSW Health.(2009)
. Detect: When to worry
. Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

Reference:
NSW Health.(n.d).
Hospital Triage
. Retrieved from http:// www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

Compare and contrast the indications and modes for metoclopramide and ondansetron.
Drugs
Ondansetron
Metoclopromide
Indication
Prevention of postoperative nausea and vomiting for those in whom N&V must be avoided,
even when incidence of postop N&V is low
.


IM; IV
Prophylaxis of postoperative nausea and vomiting
10-20mg IM near the end of surgery

Prevention of postoperative nausea and vomiting when nasogastric suction is undesirable
IM; IV
Prevent postoperative N&V
Adults and children 2-12years weighing over 40kg:
4mg undiluted given IV over 2-5min immediately before induction of anaesthesia

Drugs
Ondansetron
Metoclopromide
Modes
References:
McKenna, L. & Lim, A. C. (2012).
Karch's Pharmacology for Nursing and Midwifery
(1st Australian and New Zealand Ed.). Sydney Australia: Lippincott Williams & Wilkins
Spratto, G. R. & Woods, A. L. (2012).
Delmar Nurse's Drug Handbook
. USA: Delmar Cengage Learning
Skidmore-Roth, L. (2013).
Mosby's 2013 Nursing Drug Reference
(26th Ed.). USA: Mosby
References:
McKenna, L. & Lim, A. C. (2012).
Karch's Pharmacology for Nursing and Midwifery
(1st Australian and New Zealand Ed.). Sydney Australia: Lippincott Williams & Wilkins
Spratto, G. R. & Woods, A. L. (2012).
Delmar Nurse's Drug Handbook
. USA: Delmar Cengage Learning
Skidmore-Roth, L. (2013).
Mosby's 2013 Nursing Drug Reference
(26th Ed.). USA: Mosby
Reference:
Farrell, M., & Dempsey, J. (2011).
Smeltzer and Bare’s textbook of medical-surgical nursing
(2nd Australian and New Zealand ed.). Sydney, Australia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
References:
Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., … Stanley, D. (2012).
Kozier and Erb’s fundamentals of nursing
(2nd ed.). Frenchs Forest, NSW: Pearson Australia.
Farrell, M., & Dempsey, J. (2011).
Smeltzer and Bare’s textbook of medical-surgical nursing
(2nd Australian and New Zealand ed.). Sydney, Australia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
Reference:
Lewis, S. L., Dirksen, S. R., Bucher, L., & Camera, I. M. (2011).
Medical surgical nursing: Assessment and management of clinical problems
(8th ed.). St. Louis, Missouri: Elsevier, Mosby.
Secondary survey
Insertion or application of monitoring devices
Cleaning and dressing of wounds
Splinting of suspected fractures
Tetanus status
Next of kin and contact – obtain this ASAP
Psychosocial support available
Reference:
Farrell, M., & Dempsey, J. (2011).
Smeltzer and Bare’s textbook of medical-surgical nursing
(2nd Australian and New Zealand ed.). Sydney, Australia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
References:
Kerridge, I., Lowe, L., & Stewart, C. (2011).
Ethics and law for the health professions
(3rd Ed). Riverwood, Ligare Pty Ltd.
NSW Health. (2005). Consent to Medical Treatment - Patient Information. Retrieved from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf

Retrieved from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf

Roles of the nurse:

All practitioners, including nurses, are responsible for the advice they give to patients
Nurse practitioners are registered nurses working at an advanced practice level. They are authorised by the Nurses Registration Board of New South Wales to use the title 'nurse practitioner'.
Reference:
NSW Health. (2005).
Consent to Medical Treatment - Patient Information
. Retrieved from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf


Reference:
NSW Health. (2005).
Consent to Medical Treatment - Patient Information.
Retrieved from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf

Reference:
The Sydney Children Hospital Netwrk. (2014).
Neurovascuilar Assessmen
t. Retrieved from http://www.schn.health.nsw.gov.au/_policies/pdf/2014-9096.pdf
Reference:
The Sydney Children Hospital Netwrk. (2014).
Neurovascuilar Assessmen
t. Retrieved from http://www.schn.health.nsw.gov.au/_policies/pdf/2014-9096.pdf
References:
Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., … Stanley, D. (2012).
Kozier and Erb’s fundamentals of nursing
(2nd ed.). Frenchs Forest, NSW: Pearson Australia.

Farrell, M., & Dempsey, J. (2011).
Smeltzer and Bare’s textbook of medical-surgical nursing
(2nd Australian and New Zealand ed.). Sydney, Australia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

Kerridge, I., Lowe, L., & Stewart, C. (2011).
Ethics and law for the health professions
(3rd Ed). Riverwood, Ligare Pty Ltd. Retrieved from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf

Lewis, S. L., Dirksen, S. R., Bucher, L., & Camera, I. M. (2011).
Medical surgical nursing: Assessment and management of clinical problems
(8th ed.). St. Louis, Missouri: Elsevier, Mosby.

McKenna, L. & Lim, A. C. (2012).
Karch's Pharmacology for Nursing and Midwifery
(1st Australian and New Zealand Ed.). Sydney Australia: Lippincott Williams & Wilkins.

NSW Health.(2009).
Detect: When to worry
. Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

NSW Health. (2009).
ISBAR
. Retrieved from http://nswhealth.moodle.com.au/DOH/DETECT/content/00_worry/when_to_worry_06.htm

NSW Health. (2005).
Consent to Medical Treatment - Patient Information
. Retrieved from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf

NSW Health.(n.d).
Hospital Triage
. Retrieved from http://www0.health.nsw.gov.au/hospitals/going_to_hospital/triage.asp

Skidmore-Roth, L. (2013).
Mosby's 2013 Nursing Drug Reference
(26th Ed.). USA: Mosby.

Spratto, G. R. & Woods, A. L. (2012).
Delmar Nurse's Drug Handbook.
USA: Delmar Cengage Learning.

Ben Lottle is a 15 year old male, currently in year 10 and is planning a career in civil engineering. He and his friends were driving quad bikes on his family’s property. Ben crashed into a ditch and fell off the quad bike which rolled onto his left leg.

He has been admitted via ambulance to ED. His parents have been notified but have not arrived at the hospital yet.

Ben seems stable.

Benjamin Lottle Critical Learning Issues 1
Members:
Shristi Luitel
Phillip Tran
June Kathleen Besa
Winceslao Altes
Denise Duran
Samina Macasindil

Topic Outline
1. Patient Introduction
2. Critical Issues
a. What information will the emergency team need to prioritise Bens care?
b. Compare and contrast the indications and modes for metoclopramide and ondansetron.
c. Discuss methods of handover that may be suitable for Bens care
d. Explain the nursing assessments that you will undertake
e. What is the nurses' role in obtaining consent of a 15 year old minor?
3. References

Handover

transfer of professional responsibility and accountability for some or all aspects of care for a patient or group of patients to another person or professional group on a temporary or permanent basis.
Reference:
Bhabra, G., Mackeith, S., Monteiro, P., & Pothier, D. D. (2007). An experimental comparison of handover methods. Annals of the Royal College of Surgeons of England, 89(3), 298-300. doi: 10.1308/003588407X168352
METHODS OF HANDOVER:
1. Verbal Handover
Designated place free of excessive noise and with phone and computer access
Designated time when both parties can be present and pay attention.
Sufficient time (15-30 mins) for interactive questions and bedside review if necessary
Face-to-face allowing for questions
2. Written Handover
has a Standardised template: Patient name, age, gender, UR no, ward/bed no. • Admission date, primary consultant.
Can be combined with verbal handover serving as a take-away summary
ISBAR Template:

Introduction:
Hi, I’m John, Emergency department nurse. I am caring for Ben Lottle, Male, 15 years old. He is admitted via ambulance to ED, and is under the care of Dr. Wong.
Situation:
Ben was admitted due to a quad bike accident and injured his left leg. Ben is complaining of severe leg pain accompanied by nausea. His left leg is swollen and appears discolored.
Background:
No background story known at this stage.
Assessment:
Airway is patent, with a respiration of 18 bpm; Bp is slightly elevated due to the pain at 130/90 and pulse rate 90 bpm. Ben has GCS of 15 and is nauseated. Apart from having a swollen and discolored left leg, the Orthopaedic consultant confirmed a closed tibia and fibula fracture which requires surgery.
Recommendation:
monitor and record 4 hourly observational and neurovascular data. Watch out for compartmental syndrome. Continue IV morphine for pain and IV ondansertron for nausea as ordered. Prepare Ben and his parents for surgery. Secure consent. Give preoperative medications and do preoperative checklist.
Reference:
NSW Health. (2009).
ISBAR
. Retrieved from http://nswhealth.moodle.com.au/DOH/DETECT/content/00_worry/when_to_worry_06.htm
Full transcript