Question

A new graduate nurse is working in a surgical ward of the local hospital. She has been allocated to care for Mrs Beverly Smith, a 70-year-old woman admitted for a hemicolectomy for stage 2 bowel cancer. Mrs Smith has a history of hypertension and stage 2 Chronic Kidney Disease (CKD). Mrs Smith had her surgery yesterday and is reported to have been stable overnight. She has a midline incision closed with staples, one Belovac of with minimal haemo-serous drainage, IV 4% Dextrose in 1/5 Normal Saline running at 85mL/hr and a PCA of Morphine sulphate 100mg in 100mL Normal Saline set to deliver 1mg with each press. She has an indwelling urinary catheter draining an average of 60mL/hr.

When the nurse assesses Mrs Smith at the beginning of the shift, she appears distressed and complains of pain rated 7 out of 10 in her abdominal area. Her observations are blood pressure 140/85 mmHg, pulse 90 bpm, respiratory rate 12, oxygen saturation 92% and temperature 36.2 degree Celsius. She is unwilling to sit up in bed and has difficulty taking a deep breath.   

The nurse explains to Mrs Smith the importance of pressing the PCA button regularly. She then checks her medication chart for any orders for “breakthrough” medication. Mrs Smith has an order for oxycodone (Endone) 10mg oral PRN, so the RN asks the endorsed EN to accompany her to the locked medication cupboard, check out the dose of Endone, and administer it to Mrs Smith, checking all the “5 rights” of medication administration.

The RN continues to give care to her other patients. When she returns to the room, she notes that Mrs Smith is sleeping peacefully. Because she had a poor night, she decides not to wake her for observations and charts “sleeping” on her PCA chart. The nurse then goes to morning tea.

When she returns from morning tea, she notes that Mrs Smith is slumped down in the bed and looks very pale. She does a set of observations and notes the following:

Patient is semi-conscious, rousing to voice, unable to give a pain score, PCA history delivered dose 15 times in the last 2 hours, blood pressure 90/60mmHg, pulse 70 bpm, respiratory rate 4 breaths per minute and shallow, oxygen saturation 84%.

Question

Express the immediate priority patient problem indicated by this situation as a Nursing Diagnosis with a ‘Related to’ and ‘Evidenced by’ statement.

Question

List four immediate priority nursing actions that are required in this situation to address the identified problem and a rationale for each.

Questions

Discuss what you believe were the main patient factors and nursing or system errors, that led to this occurrence.

Question

Following treatment by the medical and nursing team, Mrs Smith is significantly improved by the time her daughter visits later.

Describe the actions required following this incident as part of NSW Health and hospital policy to address issues of patient safety and standards of care.

Question

What are the legal requirements for a Tort of negligence? Do you believe that the new graduate RN was negligent in this situation? Justify your answer.

SORRY FOR POSTING 5 QUESTIONS BUT ITS ALL BASED ON THE SAME SCENARIO

Could you use Australian standard

Answer 1

1. Ineffective breathing pattern related to hypoxia as evidenced by decreased respiratory rate,decreased oxygen saturation shallow respiration

2.The immediate priority nursing actions required at this time are

• Stop the PCA pump because this can further lead to respiratory depression
• Administer oxygen to improve the oxygen saturation
• Administer naloxone as per order to reverse its effects be aise it is an antidote
• Intubate the patient to resume normal respiration in order to treat respiratory depression and prevent failure

3.The main factors for this occurancef are

• Allowing patient to pump as many times as required to control pain
• The nurse failure to assess and monitor the patient after administering endone
• Error by not doing the PCA chart
• The nurse could have informed other colleagues to have a look on the patient meanwhile

4.The action required to be done in these types of situations are

• To ensure the nurses are trained and has some knowledge and experience when administering drugs like opioid analgesics
• Following the protocols strictly set when administering opiod analgesics

5.A tort of negligence can be imposed on the nurse because of the failure of the nurse to assess and record the PCA chart.

Making assumptions that the patient is sleeping instead of assessing medically and as per protocol

The nurse should be aware of opiods like morphine will supress respiratory system and should monitor the patient periodically and regularly to avoid any unnecessary consequences.