Patient Assessment - Deep trouble

Nurses General Nursing

Published

The aim of this "game" is to look at critical indicators in assessment.

Some of the patients in the following scenario are in "deep trouble" but some may not be. Can you identify the ones in trouble? If you can write what you think on a piece of paper.

If you feel happy to post about one of the patients please do so but don't let the cat out of the bag on all of them!!!

If you want to add another "deep trouble" patient scenario please do so - I do not have the corner on these!!!:)

Patient A)

A forty year old man with a 25 year history of heavy cigarette smoking compalining of central chest pain. Pain score 10/10. Colour - normal not pale. Sao2 98% on 4 Lpm O2. Monitor sinus rhythm with occasional PVCS - Bp 160/80. He is very restless, moving around the bed loudly complaining and demanding immediate attention and threatening to walk out. ECG is normal.

Patient B

8 year old child came in with Mother who is distraught and keep s telling everyone that "young Jimmy" was alright when she checked on him only an hour previously. Jimmy is sitting upright, with his head forward and jaw protruding. There is saliva dripping form his mouth and it is obvious he cannot swallow. He looks sick - florridly pink cheeks. Resps and sats normal but temp 38.5C. Tachycardic.

Patient C

Oversdose Vital signs within normal parameters. Monitor - sinus rhythm. Sao2 99% on 100% O2 GCS 6/14 eye opening to painful stimuli.verbal respons - nil and Motor response 3 - flexing. When you see the patient tehy are in a lateral position with a guedel airway in place (oropharyngeal airway)

I am getting tired so I might limit it to three patients for tonight but I will be back to post some more with the answers to these!

The 8 year-old seems in the deepest trouble, obstructed airway, tachycardia=resp.distress, probable upcoming pediatric code?

Patty

Specializes in ICU.

Okay turnabout is fair play Canadian

I'm not really Paeds nor ED but I would choose the first child. Being from a hot country we can get some severly ill dehydrations.

Ooooh! This IS fun!!!

This is fun!!

Sure beats algebra anyhoo. I can't wait until I'm training to do the real thing.

kiddie 4 yrs old 3day Hx malaise and cough, dehyrated, temp 38.8

I would treat the dehydration with malaise. The other kid is at least stable and with no malaise is not showing neuro deficit. Dehydration on the other hand is a slippery slope. Temps can be wrong but dehydration and neuro deficit need to be treated ASAP.

In my untrained, anything but humble opinnion.:D

I love these!!.......cause I can't affect an outcome on a simulation :p

Specializes in midwifery, ophthalmics, general practice.

I know this is a tough call but I always worry about kids with temp that dont respond to antipyrexials- there has to be a reason for the high temp and I need to find it! the other child has an obvious problems- and fluids and antipyrexials should do the trip- its probably viral. luckily - we dont see dehydrated children here- more likely to be waterlogged with all our rain!!!!! (or at least I dont see them in primary care!)

Karen

Right on, untamedspirit. Kids can look fine on the surface and a short time later can be going straight down the dumper. Their bodies compensate so well that you dont even know they are in trouble, but when they cant anymore it has been so long they take a HUGE nose dive. Heck a kid can be out 20% volume before they even start to show vital sign changes! And if a kid goes full arrest the outlook is never stellar. The whole focus of PALS is catching codes before they happen and preventing them.

Specializes in ICU.

i'll start numbering the cases so that we can keep them sorted.

case 6 mr kenevil

mr kenevil has just walked into your emegecy room he tells you he has been out playing some extreme sports and rode a bicycle down a mountainside. unfortunately he cought a tree limb across his throat and came off of his bike. he is complaining of a really sore neck - can hardly move or twist his neck. but he is less worried about this than his right arm which shows a dinner fork shape to the radius. when he breathes in you notice he has makes slight "snoring" noise. his voice is harsh and he had trouble talking.

Specializes in GERIATRICS, DEMENTIA CARE, MED-SURG.

protect his airway quick he is swelling

Specializes in NICU.

and a C-collar too.

I like this good for the critical thinking.

Case 6:

If he fractured his radius and is showing airway compromise, I am concerned with a pulmonary embolus as an emergent problem. If visual inspection reveals trauma below the hyoid then I would suspect more than just whiplash.

This pt should be intubated before the soft tissue swells to a point when the cords can't be visualized. Then all you have left is a cricoidotomy(I think that's the term).

Protect the airway

Draw a gas

Look for other blunt trauma.

Specializes in midwifery, ophthalmics, general practice.

you are all so impressive- I am learning so much...........pity I work in primary care and dont ever see any of this stuff!!

Karen

karenG:

Never let your guard down, at any time you may be presented with one of these types who waited to see the primary care physician instead of go to the ER. Just when you least expect it.....be prepared! These tips may come in handy!

Patty

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