Nurses in an emergency department should have the necessary knowledge to assess, collaborate and plan for patients in the department. They should also be conversant with the various needs of the patients that may arise. These needs may include legal issues, as is encountered by many nurses working in emergency areas (Riviello). The case provided of Jason Crawshaw is an example of a patient with medical, legal and psychological needs that are to be addressed by the nurse.

Primary assessment of the patient usually involves ABCDE (Cole, 2009). A involves assessment of the airway. Assessment of Jason would be done by observing the chest for movement, listening for air exiting the mouth and nose, observing the skin color then observing if the patient is able to converse. In the case of Jason the airway is patent as the patient can speak as he is asking for help and the whereabouts of his brother and the girlfriend.

B involves assessing for breathing. This can be achieved by measuring the respiratory rate, the saturation of oxygen and blood gas analysis (Mallet, Albaran, Richardson). This can also be done through observing the movement of the chest and the use of accessory muscles for breathing. The respiratory rate is 24 which is normal. The saturation of oxygen is 82% which is below normal. There is compromised movement on the right side of the chest; in addition there is a likelihood of injury to the sternum and the patient complains he is unable to breathe. There may be need to provide oxygen to increase the oxygen levels. There may be need to establish airway due to injury to the sternum.

C involves assessment of the circulatory system. This can be done by measuring the pulse; rate and rhythm, blood pressure, temperature, capillary refill time and the urine output (Mallet, Albaran, Richardson). The patient has a blood pressure of 140/75 and a pulse of 108. This may indicate that the patient is anxious. There may be need to sedate the patient. An intravenous access has already been established and patient is on normal saline. There is suspected injury to the sternum. Injuries to the sternum are usually accompanied by underlying organ injury, most likely the heart or the lungs (Brunner& Suddarth). There is need to monitor the heart rhythm to rule out injury to the heart.

Disability, ‘D’ is assessed by measuring the level of consciousness, blood sugar levels, and the amount of pain the patient is experiencing and papillary reaction to light(Mallet, Albaran, Richardson). The patient scored 13 on the Glasgow comma scale an indication that he is quite stable. In addition his pupils are responsive, he is able to see. There may be need to provide some pain medications for the chest pain that may be as a result of injury to the   sternum.

Exposing the patient is done to assess for abnormalities of the whole body to observe for injuries (Mallet, Albaran, Richardson). There is bilateral fracture to the femur. Splints should be applied on both legs to immobilize the fractures. There is suspected spinal injury. The patient is nursed on a spinal board to prevent further injury to the spine.

The emergency department nurse is required to work with other health professions in order to effectively manage the patient. Jason has limited breathing on the right side and pneumothrorax is suspected. It may be necessary to insert a chest tube to relieve the pneumothorax (Brunner & Suddarth). In this case the nurse may be required to support the physician in inserting the tube by being the assistant.

Bilateral tibial fracture may be managed operatively or by casting depending on the characteristics of the fracture. Closed fractures may be managed by operation or casting. Open fractures are managed by operation. If the patient requires surgery, the nurse may be required to provide preoperative care to the patient. If the fractures will be managed by casting, there may be a need to communicate to the relevant person the need for casting. The nurse should also ensure that the patient has x-rays that may be needed before casting is done.

The patient requires nutritional support. The nutritionist and the nurse are required to work together to ensure that the patient’s nutritional requirements are met. The nutritionist may prescribe the regimen and the nurse ensures that the patient gets the required feeds and in the right quantities. In the case that the patient requires nasogastric tube feeding, the nurse is required to insert the tube.

The patient has other needs that should be managed, he has chest pain as a result of blunt trauma to the sternum and he also has pneumothorax. Medical management of the patient may require prescription of drugs such as medication for pain and antibiotics to prevent infection. The nurse and the physician collaborate to effectively manage this patient, the physician by writing a prescription and the nurse by administering medication.

The two police officers informed the nurse of the death of Jason’s brother and girlfriend. Jason was asking about his brother and the girlfriend. He needs to be counseled on what happened to the two of them to avoid self blame, hopelessness and despair. It may be necessary to engage a counselor to talk to Jason about the traumatic experience he went through and the death of his brother and girlfriend. He may also need to be counseled on the fact that he may not be able to walk again for the next few months as a result of the fractures.

Jason has injury to two limbs and a possibility of spinal injury. There will be likelihood that the patient may be in complete bed rest for a while. The patient may require a physiotherapist for mobilization and to improve removal of chest secretions. During chest physiotherapy, the nurse may be required to suction the patient to remove secretions. When mobilizing the patient in bed, the nurse maybe required to observe to make a clear documentation of procedures performed on the patient.

Investigations such as chest x-ray, x-ray of the limbs and the spine may be ordered in order to confirm the various diagnoses such as tibial fracture, spinal injury and sternum injury. The radiologist will be required to perform the x- rays but the nurse may collaborate with the radiologist by assisting in positioning the patient during the x-rays. This is vital when taking the x-ray of the spine to prevent further injury.

A nurse working in the emergency department should effectively identify the patient’s needs and plan for the care of the patient. Planning is important in identifying all things that need to be done and putting them in an appropriate order according to priority. Lack of planning may lead to doing things because they have been identified first or doing things because they are simpler and bring more satisfaction after completion. This may lead to ineffective planning for the patient ( Lipe & Beasley). Planning for care ensures a more holistic approach and it also increases the nurse patient contact time.( Griffin& Dunnion)

Jason has many nursing needs. Jason has impaired breathing and low oxygen saturation, his respiratory status needs to be stabilized. The patient may need to have circulation monitored and fluids replaced due to the fracture. Jason is complaining of pain, he needs to be given pain medication and any other medication that has been prescribed. Restlessness may inhibit proper healing as there is possible trauma to the cervical spine. Jason wants to live his bed. There is need to calm him down.

The patient is complaining that he needs to pee. There may be need to fix a urinary catheter in order to relive the patient. The patient may have superficial wounds that may need to be dressed. The patient requires a bed bath due to dirt he may have from being thrown out of the vehicle and to enhance comfort. Psychological support is important following the motor vehicle crash and the death of his brother and girlfriend. The patient is thought to have been drunk when driving and did not have a sit belt on. The nurse should be able to collect information for a forensic report prior to cleaning the patient.

The family is in need of care because of the hospitalization and loss of their loved one. The nurse should facilitate family meeting the patient, they should in addition provide psychological therapy to the family and support throughout the shift.

The nurse is required to prioritize the patient needs using either the Maslow’s hierarchy of needs or a model for the prioritization of needs. This model was developed by Craven and Hirnle (Lipe and Beasley). The Maslows hierarchy identifies the needs as: Physiological needs, Safety needs of the patients, Social needs, esteem needs and Self Actualization. So the most basic needs are placed first in the priority list.

The Craven and Hirnle model organizes priorities into 3 groups: High, Low and Medium groups. High priority situations include situations that threaten life of the patient such as airway difficulties, and cardiovascular problems. They also include situations that threaten the life of a patient, pain and when the patient is very anxious.

Medium priority situations include situations that could lead to consequences that affect health negatively, by maybe causing emotional trauma (Craven & Hirnle, 2003). This include the preparation for surgery and emotional and anxiety, like in the case of Jason, anxiety of the whereabouts of his sibling and girlfriend. Low Priority situations are those situations that can be resolved with minimal interventions (Craven &Hirnle, 2003).

Jason has low saturation of oxygen; he has been put on oxygen and has on oropharyngeal airway because of injury to the sternum which was impairing breathing. The nurse should plan to monitor Jason’s respiratory rate, the partial pressure of oxygen and the expansion of the chest. These are monitored every 4hours. The nurse should in addition plan for insertion of a chest tube to relieve pneumothorax that is impairing expansion on the right side of the chest.

The Cardiovascular system is compromised because of the bilateral fracture to the tibia. The emergency nurse attending to Jason should plan to monitor the cardiovascular system by monitoring blood pressure and pulse 4 hourly. Urine output should be monitored 6hourly. The fluids should be maintained and the input output chart monitored.

CLICK BUTTON TO ORDER NOW