acute health scenario

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Scenario: The patient is a 30 year old female who has been involved in a MVA. She sustained multiple injuries which included: # Nose; # L) NOF; Compound fracture right tibia and fibula; Multiple grazes and wounds over her face, arms and legs; A contusion on her forearm; Lung contusions; Liver laceration; & oozing laceration above her right eye. Patient's observation on admission are as follows: BP-110/80; R-18; P-90; T-36.5; SPo2-98% on Hudson mask 6L; GCS-15; & Pupils- PEARL size 2. Question: are these observations within normal range for a healthy women for this age?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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I am in my first year of my nursing and from what I have researched so far, is that every vital signs in this scenario is within range but the client's pulse. It seems to be quite high. Am I heading in the right directions?

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Specializes in Pedi.

I wouldn't call a pulse of 90 "quite high". The normal adult range for heart rate is 60-100. My heart rate would be WAY higher than 90 if I got into a car accident.

Do you know what GCS is? What a normal score is? What it measures?

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Glasgow Coma Scale: this is composed of three tests, Eye Verbal & Motor response right? what do you mean by "a normal score" cause is there such thing as a normal coma score?

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Specializes in Pedi.

Yes, there is. Glasgow Coma Scale is used to assess level of consciousness and is composed of three measures. The highest possible score is 15 which would be "normal" because you expect someone to open their eyes spontaneously, be able to converse appropriately and to be able to follow motor commands.

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Oxygenation. .pt is on 6L...why? Are there any ABGs?

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Take out your watch and check the respiratory rate of the person sitting in front of you in lecture for a full minute. Then the person next to him/her. Do this for a couple of classes and then tell me what a RR of 18 tells you. Is it high or low or average-ish? I mean it. You'll be surprised.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I think your teacher want you to look up the normals for vital signs.....temp_range.jpg

adults:

  • normal temperature: oral (96.8f - 99.5f), rectal (97.3f - 100.2f), tympanic (97.2f - 100.0f)
  • normal pulse: 60 - 100
  • normal respirations: 12 - 20
  • normal blood pressure: 100 - 139/60 - 89
  • reference: expert 10-minute physical examinations, 1997, mosby's

newborn:

  • axillary temperature: 97.7f - 99.5f
  • pulse: 120 - 160
  • respirations: 30 - 60
  • blood pressure: 73/55 systolic

one-year old:

  • axillary temperature: 97.0f - 99.0f
  • pulse: 90 - 130
  • respirations: 20 - 40
  • blood pressure: 90/56 systolic

toddler:

  • axillary temperature: 97.5f - 98.6f
  • pulse: 80 - 120
  • respirations: 20 - 30
  • blood pressure: 92/55 systolic

pre-schooler:

  • axillary temperature: 97.5f - 98.6f
  • pulse: 70 - 110
  • respirations: 16 - 22
  • blood pressure: 95/57 systolic

school age child:

  • oral temperature: 97.5f - 98.6f
  • pulse: 60 - 100
  • respirations: 16 - 20
  • blood pressure: 107/64 systolic

adolescent:

  • oral temperature: 97.5f - 98.6f
  • pulse: 55 - 90
  • respirations: 12 - 20
  • blood pressure: 121/70 systolic

http://emt-training.org/baseline-vitals-sample.php

What does PERLA mean? PERLA= Pupils Equal and Reactive to Light and Accommodation What is normal pupil response? http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/pstep10.htm

What is the Glasgow Coma scale? http://www.trauma.org/archive/scores/gcs.html

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Esme12, KelRN215, 2013SNGrad & GrnTea thank you for the support that you guys, as a group, have given me with this Scenario. As a first year into Nursing I am a little nervous about the findings I have found, but I do believe that the assignment that is given to me is base-line research. 2013SNGrad: I did think of that in a sense that usually the patient would be on about 4L or less right? Would it be because of Lung contusions or Liver laceration?
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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You are right about the O2 mask....a "normal" female would require no O2 so any addition of O2 would be abnormal. So what in the above scenario would cause the patient have trouble with getting oxygen into the blood (lungs) and then making sure there is enough blood to get around? (bleeding from lacerated liver).

what do you think?

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Esme12, & GrnTea thank you for the support that you guys, as a group, have given me with this Scenario. As a first year into Nursing I am a little nervous about the findings I have found, but I do believe that the assignment that is given to me is base-line research. 2013SNGrad]: I did think of that in a sense that usually the patient would be on about 4L or less right? Would it be because of Lung contusions or Liver laceration?

Yes.

1) What happens to the lungs' ability to do gas exchange when it is contused? What's a contusion? If you had one on your leg, what would it look like? How would a lung work if it looked like that?

2) What happens with liver lacs? Do they bleed a lot? Why or why not? What does your body need to deliver oxygen? What's the difference in oxygen delivery to the tissues in a patient with an O2 sat of 98% with a hematocrit of 40 and a patient with an O2 sat of 98% and a hematocrit of 20?

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