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Additional Case: Sarah Dobinson - Coggle Diagram
Additional Case: Sarah Dobinson
Discuss how you would manage Sarah following her arrival into the emergency department. Include your nursing assessments, prioritised interventions and evaluation.
A-G assessment
AMPLE
allergies
medications
past medical history
events preceding or causing injury
last meal
Head-to-toe assessment
Pregnancy test
Full pain assessment
Oxygen therapy
Fluids – for hypotension
Pain management
Monitor closely and provide reassurance
Position patient flat (until spine is cleared), then semi fowler’s
Relate Sarah’s presenting clinical signs and symptoms to her diagnosis.
Dx: intraabdominal haemorrhage
clinical signs
Low BP – blood volume loss from trauma
Distended abdomen
High respiratory rate
Identify patient problems that may occur as a consequence of receiving massive blood and
fluid replacement.
Fluid overload – acute respiratory distress
Allergic reaction to blood products –
rash, fevers, shaking, dark urine, bradypnoea
Hypertension/hypotension
Pre-existing kidney injuries?
High amount of fluids at non-body temperature – shock
Hypokalaemia
Blood borne pathogens
Prior to collection of red cell pack
Medical order
Informed consent
Patient explanation including possible transfusion reaction
Ensure IV access patent
Baseline TPR and BP
Verification of right patient/right blood must be attended by 2 RNs
right patient
right blood product
right pack
Management of suspected transfusion reaction:
Stop the transfusion immediately
Check vital signs
Maintain IV access (DO NOT FLUSH existing line – use a new IV line if required)
Check the right pack has been given to the right patient
Notify the medical officer and Transfusion Service Provider after the transfusion is terminated (except for some types of mild reactions)
Send freshly collected blood and urine samples along with the blood pack and IV line as required by Transfusion Service Provider.
Rationalise Sarah’s post-operative orders.
NBM – reduce strain on pancreas and stomach
NG tube on gravity with 4th hourly suction – to reduce strain on digestive system
Heparin – anticoagulant to prevent clots
Post op FBC, EUC, coags – monitor infections and ensure she is not clotting (risk of clot causing liver damage) and bleeding
Cephazolin 1g BD – prophylactic antibiotic
Chest physio – ensure she is breathing adequately as she is on bedrest and has increased risk of pneumonia
Discuss the medical and nursing interventions used to improve her respiratory function
BIPAP – used instead of CPAP when positive airway pressure is needed; used when there is CO2 retention;
helps to expand the lungs and improve overall respiratory function
IV ABx – combat infection
Chest physio – minimize fluids to improve respiration
Cultures and bloods – to identify what bacteria are present
ABG – to provide respiratory and metabolic information
Encourage mobilization and deep breathing exercises
FBC – to monitor and ensure that fluid is not continuing to build up in her cavities
Pain relief – to reduce pain and improve respirations, typically compromised by pain levels
Discuss how each of Sarah’s medications may have assisted her.
Morphine – pain relief
Maxalon – nausea relief
Fentanyl – pain relief
Packed cells – restore blood volume
Oxygen – promote respiration and post-op healing
Heparin – DVT prophylaxis
Cephazolin – antibiotic
Paracetamol – antipyretic