Instructions Below Report Explained for Students (Easy Guide)
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What This Question Is About
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Key Explanation
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Original Question
Instructions Below is the report you have received from the night nurse – the hospital does not perform bedside rounds Use only the information provided below, not use any information from Part B for this part Decide in what order you will go and see the patients now that report has been given Once you have decided, write down the order you will see the patients and provide a rationale as to why you chose that order for each patient Patient A.N. A.N., an 18-year-old woman who was caught in a house fire was admitted from the ED for further treatment. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew initiated humidified oxygen at 15 L/min per nonrebreather mask and started a 16-gauge IV with lactated Ringer’s solution. On arrival to the ED, her vital signs are 100/66, 125, 34, SaO2 93%. An additional 16 gauge IV is inserted. She appears anxious and in pain. A.N. does not exhibit any signs of smoke inhalation injury. Patient J.L. J.L. is a 30-year old woman, omitted to your unit with the diagnosis of status post-cardiac transplantation and fever of unknown origin. She was healthy until the birth of her only child at 27 years of age. She developed idiopathic cardiomyopathy after childbirth and underwent cardiac transplantation 10 months ago. All of her endomyocardial biopsies have been negative for signs of rejection; her last one was 3 weeks ago. She is currently maintained on a regimen of baby aspirin, multivitamins, tacrolimus (Prograf ), nifedipine (Procardia), and metolazone (Zaroxolyn). Patient J.O. J.O., is a 25-year-old man who was a new admission who just arrived on the floor at 0600. He was involved in a motor vehicle accident (MVA) during a high-speed police chase on the previous night. His admitting diagnosis is status post (S/P) open reduction internal fixation (ORIF) of the right femur, multiple rib fractures, sternal bruises, and multiple abrasions. He speaks some English but is more comfortable with his native language. He is under arrest for narcotics trafficking, so one wrist is shackled to the bed and a guard is stationed outside his room continuously. Another drug dealer told him he is “coming to get him.” Hospital security is aware of the situation. He is on a PCA pump for pain control. J.O.’s immunization status could not be determined when he arrived, so no tetanus immunization was given. Patient T.A. Patient was transferred from the ICU at 0600. The 50-year-old male patient, T.A., is postoperative day 2 from a repair of an abdominal aortic aneurysm (AAA) measuring 8 cm in diameter. He is an attorney with an active practice. Before surgery, he routinely took medication for gastritis and has a 10-year history of type 2 diabetes mellitus (DM) requiring insulin the past 6 months to control glucose levels. Despite this, T.A. considered himself to be healthy before diagnosis of the aneurysm. The ICU tells you during report that since surgery, T.A. has experienced some weakness of his lower extremities and decreasing urinary output. Patient R.I. Before taking report on your four patients, you take the following report from the emergency department (ED) nurse: “We have a patient for you; R.I. is an 89-year-old frail woman who has been in a nursing home. Her admitting diagnosis is sepsis, pneumonia, and dehydration, and she has a known stage III right hip pressure ulcer. Past medical history includes remote cerebrovascular accident with residual right-sided weakness and paresthesia, remote myocardial infarction, and peripheral vascular disease. Her vital signs are 98/62, 88 and regular, 38 and labored, 100.4° F (38° C). Lab work is pending; she has oxygen at 10 L via face mask, an IV of D5.45NS at 100 mL/hr, and an indwelling Foley. The infectious disease doc- tor has been notified, and respiratory therapy is with the patient—they are just leaving the ED and should arrive shortly”.
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