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Group 4 - Topic 9

Jorge Guerra

Sarah Martinez

Jaylean Gonzalez

Emma Elsner

Joel Cepeda

Stone Mason

Mohammed Alobeidi

Josh Gilmartin

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Situation:
The patient is a 17-year-old gender-fluid Hispanic who presented with a fractured right humeral head consistent with blunt force trauma. The patient lacks identification documents and is accompanied by someone claiming to be their aunt. We suspect the patient may be a victim of sexual human trafficking.

Background:
The patient has multiple bruises on their torso in various stages of healing and 3 scabs from cigarette burns on their neck. They are unsure of their address. The self-identified aunt is answering all questions and refuses to leave the patient alone with the nurse for examination.

Assessment:
Vital signs are as follows:

Heart rate: 92 bpm

Blood pressure: 134/84 mmHg

Respiratory rate: 18 breaths/minute

Temperature: 37.5°C (99.5°F)

Oxygen saturation: 99% on room air

Physical examination reveals the fractured right humeral head, multiple bruises, and cigarette burn scabs. The patient appears anxious and the aunt's behavior is concerning. Given the patient's age, injuries, lack of identification, and the aunt's controlling behavior, we strongly suspect human trafficking.

Recommendation:

1. Immediate social work consult to assist with separating the patient from the aunt and to initiate appropriate interventions for a potential trafficking victim.

2. Notify law enforcement and child protective services due to the patient's minor status and suspicion of trafficking.

3. Order a full trauma workup, including head-to-toe examination, and screening for sexually transmitted infections.

4. Psychiatric consultation for mental health assessment and support.

5. Arrange for a safe, private area for further assessment and interviews once the patient is separated from the aunt.

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Psychological Trauma

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Risk for infection

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Physical Trauma

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Provide a safe and supportive environment. Use trauma-informed care principles.

WHY: to build trust and offer psychological support.

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Clean and dress wounds regularly using antiseptic techniques. Monitor for signs of infection.

Why: This assess the healing progress and promotes healing and the improvement of the patients health status. By doing this process diligently and effectively, we can catch potential complications sooner and address them more readily.

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Pain management, promotion of healing, and prevention of further injury concerns.

WHY: Managing a patients pain can reduce stress, blood pressure, heart rate, and positively effect healing. A secondary aspect of alleviating the pain of this specific patient is that it can help to build trust and rapport, which is of upmost importance when caring for a patient suspected of being involved in human trafficking.

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Priority Complication: Physical Trauma

Anticipated Orders:

-analgesics for pain management

-full trauma workup including X-ray/CT scan

-STD/STI screen

-Referral to psychiatry and subsequent evaluation

-72 hour psychiatric hold

-Referral to crisis counselor

-place patient under confidential status

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Approximately 2 hours after the initial assessment, the nurse notices the following changes:The patient's vital signs have worsened:

Heart rate has increased to 118 bpm

Blood pressure has dropped to 92/60 mmHg

Respiratory rate has increased to 24 breaths/minute

Temperature has risen to 38.7°C (101.7°F)

Oxygen saturation has decreased to 94% on room air

The patient appears more distressed and is now complaining of increased pain in the right shoulder area. They are also showing signs of confusion, having difficulty answering simple questions about their location and the current date. The nurse observes that the patient's skin is becoming pale and clammy. The bruising on the torso appears to be darkening, and there's a new area of swelling developing near the fractured humeral head. The patient is now exhibiting signs of anxiety, repeatedly asking for water and attempting to get out of bed despite instructions to remain still. They are also reporting feeling lightheaded and nauseous.

Due to the patients current state, they have now been transferred to the ICU.

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Nursing actions to transition to a higher level of care

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Nursing actions to transition to a higher level of care

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3 Priority

1. Activating the rapid response team

2. Increasing oxygen support

3. Initiating IV fluid resuscitation

4. Preparing for potential blood transfusion

5. Administering appropriate pain management

6. Ordering urgent imaging studies to identify potential internal bleeding

7. Initiating sepsis protocol if indicated

Why was our patient sent to a higher level of care?

These changes could indicate the development of hypovolemic shock, possibly due to internal bleeding from the fracture or other undetected injuries. The rising temperature and increased confusion might suggest the onset of sepsis, potentially from an infection related to the injuries or pre-existing conditions not yet identified.