Question

The patient is a 35-year-old woman who was the driver in a high-speed motor vehicle crash. EMS reports that his vehicle was struck on the driver’s side by a truck and the victim had to be

extracted using the “jaws of life.” The patient was wearing a seatbelt, and he was unconscious when EMS arrived, but he has intermittently aroused reporting extreme pain in the chest and pelvis area. He arrives secured to a backboard with a C-collar in place. His breathing is uneven and becomes increasingly more labored as he is transferred to the ED stretcher. Vital signs are respirations 35/min; pulse 125/min; and blood pressure 86/40 mm Hg; cardiac monitor shows sinus tachycardia. The resuscitation team includes an ED health care provider, primary nurse, secondary nurse, respiratory therapist, and a UAP.

1. During the primary survey, what is the highest priorityintervention?

2. When assessing breathing during the primary survey, what is included in this assessment?

3. Discuss with a classmate several ways that assessment, interventions, and responsibilities could be divided between the primary and secondary nurse. (Use your critical thinking skills and discuss your answer with your instructor.)

4. What duties would be appropriate to delegate to the UAP?

5. What is the purpose of the secondary survey?

6. Why is the mechanism of injury (MOI) important in trauma cases? In the scenario above, speculate about the relationship of the mechanism of injury and the EMS report on thepatient’s complaints and injuries.

7. Using the concept of gas exchange, explain why the patient is likely to have a nasogastric tube. Using the concept of tissue perfusion, explain why a Foley catheter would be used for a patient with severe trauma.

8. When assessing the patient, you notice a strong odor of alcohol on his breath. The lab results indicate that his blood alcohol concentration (BAC) is 0.25 mg % (250 mg/dL). Your immediate concern for the patient is the possibility of

A. Respiratory arrest.

B. Vomiting with aspiration.

C. Onset of withdrawal symptoms.

D. A need for larger doses of analgesics.

Answer 1

1. During the primary survey, what is the highest priority intervention?

As she was having a a laboured breathing,the primary intervention should be focused to clear the airway and bring back normal breathing pattern.

2. When assessing breathing during the primary survey, what is included in this assessment?

• A respiratory assessment is an external assessment of ventilation that includes observations of the rate, depth and pattern of respirations.
• An accurate assessment of respiration depends on recognizing normal thoracic and abdominal movements.
• On inspiration, the diaphragm contracts, causing abdominal organs to move downward and forward, increasing the vertical space of the chest cavity.
• At the same time, the ribs lift upward and outward, and the sternum lifts outward to aid the transverse expansion of the lungs.
• On expiration, the diaphragm relaxes upward, the ribs and sternum return to their relaxed position, and the abdominal organs return to their original position.

3. Discuss with a classmate several ways that assessment, interventions, and responsibilities could be divided between the primary and secondary nurse. (Use your critical thinking skills and discuss your answer with your instructor.)

Role of primary nurse

The primary nurse does all of the bedside care. The essence of the primary nurse's role is the acceptance of responsibility, authority, and accountability for decisions about patient care.

• Activate code blue team
• Assessment of rapid triage, assigning of the CTAs score and also facilitating all the necessary access to the required medical care
• The establishment and also the maintenance of the airway, especially in cases of serious neck or head injuries
• The regular monitoring of the vital signs like the pulse, blood pressure, respiration etc.
• The regular monitoring of the neurological status
• The performing of a complete ‘head to toe’ assessment with the purpose of identifying and treating of all injuries
• Following the right way of getting a complete surgical as well as medical history
• Bring Emergency Resuscitation Cart
• Place backboard under patient
• Initiate 2 man Cardio Pulmonary Resuscitation
• Administer ventilations with 100% O2 with Bag/valve/mask
• Attach Electro cardiogram leads
• Attach “hands off” defibrillator pads
• Ensure patient Intra Venous access
• Prepare suction
• Obtain supplies from CPR Cart/Ward Stock

Secondary nurse

• secondary nurse to assist physician in performing patient care.
• The secondary nurse will wait for direction from a physician as to what interventions they will perform. Assessment, interventions, evaluation of interventions.
• Communication with physician or primary care provider.
• Making arrangement and providing oxygen or/and mechanical ventilation or/and assistance with the means of intubation in order to maintain the breathing
• Providing the right amount of blood products, IV fluids, and medications that are as per the doctor’s orders
• The arrangement of the diagnostic and laboratory testing equipment as per the orders of the doctor (MRI, CT etc.)
• Anticipation, Recognition & Response to the various changes or deteriorating conditions of the patient condition
• Reporting of the lab results, results related to diagnostic imaging and the various changes in the condition of the patient to the physician
• Providing adequate emotional support & teachings needed by the patient and the patient’s family in this difficult hour
• If the patient is being discharged and allowed to go home from the E.R., the nursing care service provider must provide the discharge teaching
• The nursing care provider should explain the patient’s family members regarding the symptoms and signs that require immediate medical care, the necessary assessments, and the tentative recovery course

4. What duties would be appropriate to delegate to the UAP?

Unlicensed assistive personnel (UAP) are unlicensed health care providers trained to function in a supportive role by providing patient/client care activities as delegated by the RN. The term includes, but is not limited to nurse aides, orderlies, assistants, attendants, or technicians. UAP function under the nurse practice act of each state.

The responsibilities and duties of a UAP include:

• Observing, documenting and reporting clinical and treatment information, including patients' behavioral changes
• Assisting with motion exercises and other rehabilitative measures
• Taking and recording blood pressure, temperature, pulse, respiration, and body weight
• Assisting with ambulation and mobilization of patients
• Collecting specimens for required medical tests,
• Providing emotional and support services to patients, their families and other caregivers
• Assisting with personal hygiene: bathing, oral hygiene, nail care, and grooming
• Assisting with dressing, repositioning, feeding, and toileting