Question

You are an ED nurse with a 4-bed assignment. Currently, 3 rooms are occupied by patients that recently arrived.

1. 38 yo male ambulatory to ED with complaints of sneezing yesterday and then developing a sudden sharp pain on the left side. Pt reports pain increases with cough. Denies SOB and is in NAD in triage. VS WNL

2. 4-week-old male arrives with his mother. She states that he has had some congestion and coughing for 1 week, is eating less and had a rectal temperature of 100.7 at home. The child was born at 32 weeks gestation and spent 2 weeks in the NICU. In triage you note retractions with respirations. VS: T 37.8, HR 184, RR 40, Pulse ox 92% RA

3. 27 yo female ambulates to triage complaining of a mass to her arm. Pt reports that she had an I&D of the mass at urgent care 2 days ago and started antibiotics. The swelling and redness is increasing per the patient. When questioned she admits to IV drug use. VS WNL

For each patient, answer the following questions:

1. What ESI level would you give this patient? And then rank the patients in the order in which you would see.

2. Based on this initial presentation, what potential medical diagnoses do you suspect? List as many as you can.

3. What further questions do you want to ask your patient?

4. What red flags are you looking for?

5. What diagnostic tests do you expect?

6. What is your top nursing diagnosis?

7. What interventions do you anticipate?

8. What can you delegate, and to whom?

9. What is the best- and worst-case scenario for this patient?

Based on your answers, how do you anticipate planning your care for the next hour?

Answer 1

Answer: Patient 1

Medical diagnosis: Muscle strain

The patient developed sudden sharp pain after sneezing which increase with cough.While sneezing it can put pressure on the muscles in the back and cause a spasm of pain.In some cases,a particularly forceful sneez can actually cause a muscle strain.Patient VS WNL.So no chances of plurisy.

1) ESI level - 5

2)Medical diagnosis: Muscle strain,Common cold,Pleural

effusion,Pulmonary embolism

3) Do you have watery eyes and nasal congestion.

4)Plural effusion

5)A complete Blood Count and chest X-ray

6)Top nursing diagnosis discomfort due to pain

7)Intervention: Apply ice to induce vasoconstriction,which will reduce blood flow to the site of injuries. Never ice for more than 20 minutes at a time

Compression: Wrap the strained area with a soft-wrapped bandage to reduce further diapedesis and promote lymphatic drainage.

8) Delegate to patient care assistant

9)best scenario pain get relieved after application of ice and compression.

worst scenarios patient get SOB

FDAR for the patient

F: Discomfort due to pain

D: VS WNL,Pain during coughing

A: Apply ice and compression

R: Observe for pain reduced

Patient 2

1) ESI: Level 2

2) RSV(Respiratory syncytial virus infections)which is common among premature born babies  or influenza.

3) Did the congestion interfe with breathing or having fever.

.4) Red flag for pneumonia

5)Chest X-ray

6)Remove nasal congestion and breathing easy

7)Intervention anticipate for warm bath,which can help clear congestion and offer a distraction,regular feeding , add one or two drops of saline to nostril ,provide steam

8)Delegate to patient care assistant above interventions

9) best case scenario is RSV infection is common among babies and goes away within 1 to 2weeks.

FDAR

F: Relieve congestion to breath easily

D: Temperature 37.8,HR 184 and spo2 92%RA

A: Saline drop,steam for relieving nasal congestion

R : Relieved  congestion after the interventions

Patient 3)

1)ESI : 5

2) Cellulites at injection site in drug users.

3)Do you have fever

4)Sepsis

5)CBC

6) pain redness and swelling due to infection

7) Do warm compress.The heat may help the infection by promoting drainage.Applying warm compress on the affected area for 30 minutes four times per day may help the abscess heal on its own.Protect from contamination

8) Delegate the warm compress to patient care assistant.

9) Best scenario heal the abscess and worst is sepsis

FDAR

F: pain redness and swelling

D: incresing redness and swelling

A: Warm compress

R: Relief of pain and redness.