Question

John Taylor is a 68-year-old African American male with a history of type II diabetes, coronary artery disease and hypertension. He came to the emergency department (ED) triage window because he felt crummy, complaining of a headache, runny nose, feeling weaker, “achy all over” and hot to the touch and sweaty the past two days. When he woke up this morning, he no longer felt hot but began to develop a persistent “nagging cough” that continued to get worse throughout the day. John is visibly anxious and asks, “Do I have that killer virus that I hear about on the news?”

John lives in a large inner-city that has had over three thousand confirmed cases of COVID-19. He has been married to Maxine, his wife of 45 years, and is a retired police officer and active in his local church.

The patient is in the Triage Area:

What data from the present problem and social history do you NOTICE as RELEVANT and why is it clinically significant?

RELEVANT History of Present Problem Data and its clinical significance?

RELEVANT Data from Social History and its clinical significance?

What additional clarifying questions do the triage nurse need to ask John to determine his risk for COVID-19?

What type of isolation precautions does the nurse need to implement if COVID-19 is suspected? What specific measures must be implemented to prevent transmission?

Type of Isolation, Rationale, and Implementation Components?

Emergency Department:

Mr. Taylor is brought into one of the rooms in the emergency department. The nurse collects the following information:

Current Vital Signs	P-Q-R-S-T Pain Assessment
T 100.3 F (oral)	Provoking/Palliative	“Moving makes it worse.”
P: 118 regular	Quality	“Achy”
RR: 22 regular	Region/Radiation	“All over”
BP: 164/88	Severity	5/10
SaO2 92% on Room Air	Timing	continuous

What VS data are RELEVANT and must be NOTICED as clinically significant by the nurse?

RELEVANT Vital Sign and Pain Assessment Data:?

Clinical Significance and Relationship to Past Medical History and Current Situation:?

The nurse performs a FOCUSED assessment. (perform the most critical assessments)

Nursing Assessment Findings

• General Survey: Appears anxious, body tense

• Neurological: Alert & oriented to person, place, time, and situation. Generalized weakness.

• Respiratory: Breath sounds fine dry crackles bilat. with diminished aeration on inspiration and expiration in all lobes anteriorly, posteriorly, and laterally, non-labored respiratory effort, episodic nonproductive cough.

• Cardiac: S1 and S2 audible, rhythm regular. No edema.

• Integumentary: Skin hot, dry, intact. Color appropriate for ethnicity

What assessment data is RELEVANT and must be NOTICED as clinically significant by the nurse?

Collaborative Care: Medical Management

The emergency department physician assesses Mr. Taylor and orders the following:

State the rationale and expected outcomes for the medical plan of care?

Contact-Airborne-Droplet precautions: rationale and the expected outcome

Influenza swab: rationale and the expected outcome

COVID-19 swab (only if influenza negative): rationale and the expected outcome

Chest x-ray: rationale and the expected outcome

Complete Blood Count (CBC): rationale and the expected outcome

Metabolic Panel (BMP): rationale and the expected outcome

Serum Lactate: rationale and the expected outcome

Oxygen per nasal cannula. Titrate to keep SaO2 92% or better: rationale and expected outcome

What diagnostic testing results data is RELEVANT and must be NOTICED as clinically significant by the nurse?

Lab Tests	Results	Lab Tests	Results
WBC	2.3 103/microL	Na+	143 mEq/L
Hgb	6.5 g/dL	K+	4.1 mEq/L
Hct	17%	Cl-	101 mEq/L
Platelet Count	85 109/L	BUN	28 mg/dL
% Neutrophils	92	Cr	1.5 mg/dL
% Lymphocytes	8	Glucose	178 mg/dL
% Monocytes	0	Lactate	1.9
% Eosinophils	0	Influenza	Negative
% Bands	0	COVID-19	Positive

What lab results are RELEVANT and must be NOTICED as clinically significant by the nurse?

Prioritization of orders:       Rationale:

The physician tells Mr. Taylor that his COVID-19 test was positive and that he will be admitted to the hospital.

What is the patient likely experiencing/feeling right now in this situation? What can you do to engage yourself with this patient’s experience, and show that he/she matters to you as a person?

The Emergency Department Nurse must give report to the nurse on the medical floor who will be receiving Mr. Taylor. Use the SBAR (Communication form to document the nurse-to-nurse report

S (situation)

B (background)

A (assessment)

R (recommendation)

The patient is transferred to the medical-surgical floor of the hospital. You are the nurse on the floor who settles the patient in bed in a negative air flow room and obtains the health history and performs a physical assessment. The health history is listed in the “History of Present Problem.” The patient denies any surgeries in the past. He said that he had a flu shot this season and a pneumonia vaccine when he turned 65.

Home Medications

Metformin 1,000 mg PO daily

Amlodipine 10 mg PO daily

Atenolol 50 mg PO daily

Physical Assessment

• General Survey: Appears Anxious, body is tense.

• Head Face, Neck: Head is round, face symmetrical, neck range of motion intact, no swelling.

• Eyes, Ears, Nose, Throat: eyes symmetrical, scleral white, conjunctiva is pink, teeth white, lips, tongue and oral mucous membranes are dry, hearing intact

• Neurological: Alert & oriented to person, place, time and situation. Generalized weakness

• Respiratory: Breath sounds fine dry crackles bilat. with diminished aeration on inspiration and expiration in all lobes anteriorly, posteriorly, and laterally, non-labored respiratory effort, episodic nonproductive cough.

• Cardiac: S1 and S2 audible, rhythm regular. No edema.

• Peripheral Vascular: Radial pulses strong and equal, skin of upper extremities is warm, and color is appropriate for ethnicity, capillary refill of is less than 3 sections on fingers. Pedal pulses are not palpable, skin over lower legs and feet is pale and slightly cool to touch. Capillary refill on toes is 5 seconds.

• Integumentary: Skin hot, dry and intact. Skin turgor is brisk. Color is appropriate for ethnicity.

• Braden Scale:

  • Sensory perception no deficit

  • Moisture no problem

  • Activity ambulates

  • Nutrition potential problem

  • Friction and shear no problem

• Musculoskeletal: Upper and lower extremities and are strong weak, with full range of motion.

• Morse Fall Scale

  • No history of falling

  • Secondary diagnosis: yes

  • Ambulatory aid: none

  • IV: saline lock

  • Gait/Transferring: independent

  • Mental status: intact

• GI: Abdomen is round and soft with bowel sounds in all 4 quadrants. Last BM was yesterday, soft brown stool.

• GU: Voiding without difficulty, urine clear amber. Last void was this morning at 0500.

• Mental Health: Behavior is appropriate for the situation. Anxious. He is retired.

• Intervention (lines, drains, etc.): IV: saline lock left forearm, site clean and dry, dressing dry and intact.

• Wounds/Incisions/Ostomies: None

Based on Mr. Taylor’s age and past medical history, he is at risk for developing complications that could lead to severe illness.

How will you monitor for early signs that his health status is deteriorating and he is experiencing complications of the virus COVID-19? What do these signs indicate?

Change in condition: and Clinical Significance:

Answer 1

Question No.a

What data from the present problem and social history do you NOTICE as RELEVANT and why is it clinically significant?

Answer:

COVID-19 is a Pandemic disease which spreaded throughout the world. Its highly infectious. The Virus spread all America and approaches community transfer.

So in this case of Mr. John Taylor Medical healthcare providers at once can point out towards COVID-19 if there is some correlated symptoms like Coughing, headache and bodyache, feeling tired,fever then their are more chances that Mr. John Taylor got COVID-19 disease. Higher Age factor and Diabetic are vital signs that patient have weak immune system.

His wife is socially active in local Church and inner-city has high number of active cases present. So in the area where this type of infectious virus is spreading throughout community more relevant chances are there to got the infection.

These things are clinically significant because it is very necessary for early diagnosis and treatment.

Question No.b

Relevant History of Present Problem Data and its clinical significance?

Answer:

Mr. John have a history of Diabetes, hypertension and cardiac disease. These are the disease which makes Mr. John more vulnerable towards the COVID-19 disease and helps to understand the severity of need and arrangements for healthcare emergencies like Ventilators, ICU.

Question No.c

Relevant Data from Social History and its clinical significance?

Answer:

Mr. John is related with African American,the community highly infected with virus because of various reasons. Although wife is also social active like she goes in church in these days of Pandemic. Looks like that she will act as a carrier of virus which infect Mr.John.

​​​​​Question No.d

What additional clarifying questions do the triage nurse need to ask John to determine his risk for COVID-19?

Answer:

Other additional clarifying questions do the triage nurse need to ask John to determine his risk for COVID-19 are that if the patient have any breathing problems, sore throat, loss of taste or smell. Diahorria is also uncommon symptom for which a nurse can ask for.

Also nurses and other health authorities can ask for the places Mr. John visited within two weeks to draw an conclusion and forward patient for COVID-19 testing. If Mr. John found positive then authorities may spread awareness among other people.