Action/intervention and rationale for Tachycardia

[ramona1993]

Hi guys,I'm a nursing student and I'm currently working on an assignment and am really struggling with those questions. I think I am probably over thinking things but I need help.

the case scenario is:

You have gained employment as an Enrolled Nurse at the hospital in your town.

Mrs Martha Brown, aged 76, her daughter, Mrs Julie White aged 38, and Julie's son, Danny White who has just had his 3rd birthday, are all admitted into your ward following a motor vehicle accident.

Mrs Brown does not remember the accident and the medical officer has written she had a loss of consciousness.

Mrs White has a broken leg which is now in a plaster cast.

Danny had been restrained in his car seat and sustained cuts and bruises.

The questions I am strugling with are:

1. When you were assessing Mrs Brown on day 2, her pulse was 126 beats per minute and was irregular.

• Prioritise and list the interventions/actions you would undertake within your current scope of practice and provide your rationale for each action.
  

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2. Your mother has heard that her friend, Mrs Brown, was admitted to hospital. When you arrive home after your shift, your mother asks you for information about Mrs Brown's condition. Provide a monologue of your response to your mother.

Any help would be greatly appreciated :)

[cracklingkraken, ASN, RN]

What are some of your ideas?

[ramona1993]

this is what I have so far for the first question, I am unsure though how to explain the rationale?

Interventions/Actions Rationale

· Report to RN and Doctor

· report in progress notes – for abnormal findings

· Compare with apical beat

· reassess vital signs and report findings,

· possible ECG,

· medication to lower pulse,

· MET call for pulse over 129?

as for question to I know that according to the codes of ethics nurses are not permitted to disclose information to individuals who are not directly related to the healthcare of that patient, but I am unaware of what/how much we can talk to family/spouses about.

[ramona1993]

this is what I have so far for the first question, I am unsure though how to explain the rationale?

Interventions/Actions Rationale

· Report to RN and Doctor

· report in progress notes – for abnormal findings

· Compare with apical beat

· reassess vital signs and report findings,

· possible ECG,

· medication to lower pulse,

· MET call for pulse over 129?

as for question 2 I know that according to the codes of ethics nurses are not permitted to disclose information to individuals who are not directly related to the healthcare of that patient, but I am unaware of what/how much we can talk to family/spouses about.

[KelRN215, BSN, RN]

as for question 2 I know that according to the codes of ethics nurses are not permitted to disclose information to individuals who are not directly related to the healthcare of that patient, but I am unaware of what/how much we can talk to family/spouses about.

NOTHING that includes identifying information. You cannot acknowledge to your mother that you cared for Mrs. Brown. You cannot acknowledge that she was a patient in your hospital.

My mother has a habit of asking me about patients on the news. I just tell her "I can't discuss anything related to the hospital." It used to happen often when I was a bedside nurse that high profile cases (mostly shaken babies) were on my floor. My mother would constantly ask "did you take care of that baby on the news?" despite the fact that I repeatedly told her that I would not discuss it with her.

I had a patient who lived in the town I grew up in earlier this year. It took about six seconds for her mother and I to realize that my mother had been her (the mother's) 3rd grade teacher. Even though she told me her maiden name and said "your mother will remember me and my sister, tell her we said hi", I have never once mentioned anything to my mother about this. The child has cancer and the family has been very open about it- the entire town knows and has participated in events to support her, they have a Facebook page, etc. My best friend is the child's sister's adjustment counselor. We have not discussed it but she knows that I know the child and I know that she does, just because of what our jobs are. I also once cared for a former teacher's child. I recognized her immediately and it took slightly more than six seconds for her to say "you look familiar", to which I immediately responded with "you were my 8th grade gym teacher." Saying "I took care of a former teacher's child" to people from my town/who know teachers isn't a violation because there are many children of the dozens of teachers I had over the years. Saying "I took care of our 8th grade gym teacher's child" identifies the child. Saying it on an anonymous message board is also different than saying it to people who I grew up with/who would be able to identify this teacher.

[jj224]

Check blood pressure.... Assess for pain..

[bgxyrnf, MSN, RN]

1. When you were assessing Mrs Brown on day 2, her pulse was 126 beats per minute and was irregular.

• Prioritise and list the interventions/actions you would undertake within your current scope of practice and provide your rationale for each action.
  

​

There is not much that you can do within your current scope besides assess the patient and consult the physician.

Since the patient had a positive LOC, my initial focus would be on neuro status. Tachycardia can also be a sign of pain though it would typically be sinus tach (that is, regular) not irregular which suggests possible a-fib which is not uncommon among 76 year old patients. Perhaps the patient normally takes meds to control her heart rate but in her (presumed) concussed state did not reveal this to the doc and hence meds were not continued.

In addition to a thorough assessment of the patient with full set of vitals, I would review the VS trend over the last 24 hours, ensure that all scheduled and PRN meds have been given, and then do a 12-lead prior to calling the doc. If the patient is unsure about her medical history or medications, I would solicit permission to speak to her daughter who would likely know her mother's medical history and medications.