Question

A patient on your team is experiencing difficulty breathing. There is no change in the patient's status after you elevate the head of bed, apply oxygen, have the patient use pursed lip breathing, and obtain a breathing treatment for the patient. Auscultation of the lungs demonstrates crackles bilaterally halfway up the lungs. The respiratory rate is 40 breaths/min, with an oxygen saturation level of 90% on 4 liters oxygen per nasal cannula. The patient is restless and having difficulty speaking because of the shortness of breath. After exhausting all nursing interventions, you call the physician by telephone regarding the change in patient's status

1. Describe how you would communicate the following areas using the I-SBAR-R tool.
2. The physician orders Lasix 40 mg IVP and morphine 4 mg IVP and 1 to 2 mg IVP every 1-hour prn. You write down the telephone order and hang up. Your transcription includes the following information:
   • Lasix 40 mp IVP Stat and QD
   • MSO4 4.0 mg IVP Stat and 1.0-2.0 mg IVP q1hr prn

Is this the correct transcription of the order? How would you change it?

3. Did you take the telephone order correctly? What additional steps should be followed?
4. What tips for communicating with physicians on the telephone can you recall from the textbook chapter? Which of these were missing, done incorrectly, or not done during the communication with the physician? Which steps still need to be done?

Answer 1

A

INTRODUCTION

Hello doctor   .. its .... one of the RN from medical ward. Iam calling because of one patient situation cant handle by nursing intervention

SITUATION

Ms...she has had a breathing difficulty I elevated head of bed and connected oxygen but patient still suffering difficulty in breathing

BACKGROUND

patient is in our team

patient is restless and have difficulty in speaking because of shortness of breath .patient vitalsigns checked 90% saturation in nasal cannula by 4 litre oxygen,40 breath per minute .

ASSESMENT

auscultation of the lungsshows crackle halfway up the lungs .

REQUESTING ACTION FOR PATIENT SAFETY

can u please advise medicine order

2 no its not correct prescription

a. inj. Lasix 40 mg can be done as a stat dose .in this situation

but continue with QD is depending upon patient condition.

if the urinary output is good,and depend upon electrolyte result of the patient.

b. inj.morphine 4 mg can be given in iv stat but continuing dose is unnecessary it will result respiratory depression

How to change

a.inform the physician and explain the effects of drugs,sideeffects,and changes in prescription

3

a) always be clear about patient condition with present complaints

b).review the treatment and convey thouroghly

c).collect evidence on reason for changing the dose

d) make call to physician after kept ready all information

e) repeat all things to physician

f.) tell the needness for changing the dose