Patient Introduction A 52-year-old patient has just arrived in the Emergency Department with complai. Question
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Asked by ProfHeatMonkey101
Patient Introduction
A 52-year-old patient has just arrived in the Emergency Department with complaints of severe abdominal pain, nausea, and vomiting over the last few days. His abdomen is distended. He has poor skin turgor and dry mucous membranes. He has not urinated since yesterday. He has felt “dizzy” and “weak” all evening. He thought it might be the flu, but decided to come in because the stomach pains were getting worse. He has signed informed consent for treatment and labs have been drawn.
Feedback Log
0:00 You arrived at the patient’s side.
0:00 You introduced yourself.
0:10 Patient status – ECG: Sinus tachycardia. Heart rate: 129. Pulse: Present. Blood pressure: 110/78 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37 C)
0:18 You washed your hands. To maintain patient safety, it is important to wash your hands as soon as you enter the room.
0:41 You identified the patient. To maintain patient safety, it is important that you quickly identify the patient.
1:10 Patient status – ECG: Sinus tachycardia. Heart rate: 129. Pulse: Present. Blood pressure: 109/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37 C)
2:10 Patient status – ECG: Sinus tachycardia. Heart rate: 129. Pulse: Present. Blood pressure: 108/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37 C)
2:14 You put an emesis basin at the bedside. This was a good idea.
2:32 You verified signed consent. This is reasonable.
3:10 Patient status – ECG: Sinus tachycardia. Heart rate: 129. Pulse: Present. Blood pressure: 107/77 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37 C)
3:37 You asked if the patient was allergic to anything. He replied: ‘Yes. I’m allergic to demerol. I got a skin rash the last time.’
3:57 You looked for normal breathing. He is breathing at 28 breaths per minute. The chest is moving normally on both sides.
4:10 Patient status – ECG: Sinus tachycardia. Heart rate: 129. Pulse: Present. Blood pressure: 108/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37 C)
4:30 You attached the pulse oximeter. It is a good idea to monitor the saturation and pulse here. This will allow you to reassess the patient continuously.
5:10 Patient status – ECG: Sinus tachycardia. Heart rate: 129. Pulse: Present. Blood pressure: 108/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37 C)
6:03 You placed a nasal oxygen cannula. This was part of your orders.
6:10 Patient status – ECG: Sinus tachycardia. Heart rate: 129. Pulse: Present. Blood pressure: 109/78 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 90%. Temp: 99 F (37 C)
6:15 You turned the oxygen on.
6:33 The oxygen rate was 10 L/min. The recommended oxygen rate for the nasal oxygen is 1 – 6 L/min.
6:36 You checked the temperature at the mouth. The temperature was 99 F (37 C).
6:53 You looked for normal breathing. He is breathing at 28 breaths per minute. The chest is moving normally on both sides.
7:10 Patient status – ECG: Sinus tachycardia. Heart rate: 126. Pulse: Present. Blood pressure: 105/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 93%. Temp: 99 F (37 C)
7:44 You measured the blood pressure at 108/76 mm Hg. It is appropriate to monitor the patient by measuring the blood pressure.
8:10 Patient status – ECG: Sinus tachycardia. Heart rate: 123. Pulse: Present. Blood pressure: 107/76 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 95%. Temp: 99 F (37 C)
8:13 You checked the radial pulse. The pulse is strong, 125 per minute and regular. It is correct to assess the patient’s vital signs.
8:44 You checked the carotid pulse. The pulse is strong, 125 per minute and regular.
9:10 Patient status – ECG: Sinus tachycardia. Heart rate: 122. Pulse: Present. Blood pressure: 104/75 mm Hg. Respiration: 28. Conscious state: Appropriate. SpO2: 96%. Temp: 99 F (37 C)
9:36 You listened to the lungs of the patient. The breath sounds are normal.
9:59 You listened to the heart of the patient. There were only normal heart sounds.
10:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 105/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
10:25 You listened to the abdomen of the patient. You could hear hyperactive sounds from the abdomen.
10:44 You asked the patient if he had any pain. He replied: ‘Yes, I have some pain.’
10:54 You asked: How bad is the pain? He replied: ‘Not too bad, it’s about a 4.’
11:09 You asked the patient if he could describe his pain. He replied: ‘It’s a cramping kind of pain in my stomach.’
11:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 108/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
11:26 You asked the patient if anything made the pain better. He replied: ‘Vomiting makes me feel less bloated for a short time.’
11:38 You asked the patient if anything made the pain worse. He replied: ‘Any movement really’
12:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 105/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
13:04 You tried to assess any IVs, but the patient didn’t have any.
13:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 106/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
13:27 You obtained IV access in the hand. It’s correct to obtain IV/IO access here.
13:56 You obtained IV access in the arm.
14:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 106/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
After inserting an IV, you must flush the cannula.
15:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 108/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
16:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 105/75 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
17:10 Patient status – ECG: Sinus tachycardia. Heart rate: 121. Pulse: Present. Blood pressure: 106/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
17:30 You started a bolus of 500 mL normal saline, given over 30 minutes. It is important to use the basic rights of medication administration to ensure proper drug therapy..
18:10 Patient status – ECG: Sinus tachycardia. Heart rate: 120. Pulse: Present. Blood pressure: 108/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
18:24 A 2 mg dose of morphine was injected IV. You should consider administering this drug slowly. It was reasonable to give an opioid here.
19:10 Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure: 106/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
19:22 You administered 5 mg of ondansetron.
19:45 You asked the patient if the pain was better after the medication. He replied: ‘It’s the same.’
20:10 Patient status – ECG: Sinus tachycardia. Heart rate: 118. Pulse: Present. Blood pressure: 107/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
20:55 You requested an abdominal x-ray.
21:10 Patient status – ECG: Sinus tachycardia. Heart rate: 117. Pulse: Present. Blood pressure: 109/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
22:10 Patient status – ECG: Sinus tachycardia. Heart rate: 117. Pulse: Present. Blood pressure: 107/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
22:32 You took a venous blood sample. This was correct as part of completing the order for a metabolic panel.
23:10 Patient status – ECG: Sinus tachycardia. Heart rate: 116. Pulse: Present. Blood pressure: 108/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
23:24 You placed a nasogastric tube.
23:53 You asked the patient if the pain was better after the medication. He replied: ‘It’s the same.’
24:10 Patient status – ECG: Sinus tachycardia. Heart rate: 116. Pulse: Present. Blood pressure: 107/77 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 97%. Temp: 99 F (37 C)
24:11 You asked: How bad is the pain? He replied: ‘Not too bad, it’s about a 3.’
25:10 Patient status – ECG: Sinus tachycardia. Heart rate: 116. Pulse: Present. Blood pressure: 106/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C)
25:37 You attached a 3-lead ECG. It is correct to attach the monitor to the patient.
25:40 You disconnected the 3-lead ECG.
25:57 You assessed the patient’s IVs. The sites had no redness, swelling, infiltration, bleeding, or drainage. The dressings were dry and intact. If you are in doubt, it is always a good idea to reassess any IVs the patient has.
26:10 Patient status – ECG: Sinus tachycardia. Heart rate: 115. Pulse: Present. Blood pressure: 107/76 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C)
26:22 You provided patient education. This is correct. It is important to use every opportunity to provide patient education.
You should reassess the patient’s nausea at this point.
26:59 You phoned the provider in order to discuss the patient.
27:10 Patient status – ECG: Sinus tachycardia. Heart rate: 115. Pulse: Present. Blood pressure: 109/78 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C)
28:10 Patient status – ECG: Sinus tachycardia. Heart rate: 115. Pulse: Present. Blood pressure: 111/78 mm Hg. Respiration: 29. Conscious state: Appropriate. SpO2: 98%. Temp: 99 F (37 C)
28:33 A patient handoff was performed.
Vomiting results in a loss of hydrogen ions and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis. Dehydration and acidosis develop from loss of water and sodium. With acute fluid losses, severe hypovolemia and hypovolemic shock may occur, and fluid resuscitation is critical. Treatment of metabolic alkalosis is aimed at reversing the underlying disorder (small bowel obstruction, in this patient). Severe dehydration is managed by administering sodium chloride (isotonic) fluids to restore normal fluid volume. Serial abdominal x-rays are used to assess progress. In this case, the obstruction is secondary to adhesions from prior surgeries.
You got 97%
Please answer the following questions.
1-Vitals –
2-Labs
3-Patients Information
4-Chief Complaint
5-History Medications
6-Write a Soap Notes
7-Screenings
8-Orders
9- Patients Education (at least 2)
10-Write SBAR
11-Care Plan (at least 2) Assessment, Diagnosis, Outcome/Planning, Intervention and Evaluation.
SCIENCE
HEALTH SCIENCE
NURSING
NUR 4525
Patient Introduction A 52-year-old patient has just arrived in the Emergency Department with complai
