Michaela, a 19-year-old university student, was participating in a university netball sports activity when she suddenly became breathless and dizzy. She was unable to continue running and had to stop and sit down. The first aider was called, and following assessment the first aider decided to call an ambulance to transport Michaela to accident and emergency.

Background:

Michaela has a history of mild asthma, which is well-controlled with her inhaler. She uses her inhaler as prescribed and has not had any recent episodes of breathlessness. She is otherwise fit and healthy, with no other significant medical conditions.

Assessment:

On arrival at A&E, Michaela is sitting on a trolley, looking anxious and short of breath. Her respiratory rate is 28 breaths per minute, and her oxygen saturation is 92% on room air. Her blood pressure is 110/70 mmHg, and her heart rate is 100 beats per minute. Her temperature is 37.2°C.

Response:

Based on the NEWS2 score what would your decision be give a rationale for your plan of care.

Background: Mrs. Johnson's medical chart notes indicate that she is taking medication for her dementia, including donepezil and memantine. She has a history of falls in the past, and her primary care physician has been monitoring her condition closely. Yesterday, Mrs. Johnson fell at home and hit her head, which may have exacerbated her symptoms.

Assessment: As you enter Mrs. Johnson's room, you notice that she is sitting in bed, looking agitated and restless. She appears disoriented and confused, not knowing where she is or why she is there. When you ask her about her pain level, she responds with rambling statements and doesn't seem to understand your questions. Her vital signs are within normal limits, but she is hypertensive and tachycardic.

Recognition: Based on your assessment, you recognise that Mrs. Johnson's agitation may be related to her dementia symptoms, which may be exacerbated by her recent fall and head injury. You also recognise that her ability to provide informed consent for medical treatment may be impaired due to her cognitive impairment.

As a year 1 student, you are tasked with assessing Mrs. Johnson's mental capacity to make decisions about her medical treatment. What criteria would you use to determine if Mrs. Johnson has the capacity to make decisions:

2) Safeguarding, child wellbeing, No parental guidance, infection risk, Parental classes, poor timing for the child to be checked (12 hours after incident), poor child supervision

3) Confusion, impacts on wellbeing, can understand irregular symptoms, positive nursing experience to aid healing, possibly past trauma, determination through crisis,

Physical assessment : Vital signs to be done to query any health conditions such as any prone infections, since she has been homeless for 9 months. To check her Blood Pressure, Respiration, Pulse, Temperature and her saturation level. To check her urine dip sample.

Mobility assessment : Assess Frankie's level of mobility. If she would need support or is independent.

Pain assessment : Since she is experiencing discomfort pain scale needs to be done to know the level of the pain.

Check her sacral areas, body map to completed for Frankie.

stool assessment : to ask Frankie her history of bowel movement.

Food and Fluid: Ask Frankie her output of food and fluid.

Family connection which can include children, relatives any family of sort.

Substance of abuse of asking if she uses any hard drugs or is she on any medication.

Health history: any IBS , any previous health condition.

2) Safeguarding, poor timing of seeking help for child after 12 hours, poor supervision, parental classes possibly.

3) Determination through crisis, vivid memory but unable to remember past 2 weeks, positive nursing experience, possible past trauma

1) Prioritisation 1, 2 and 3

2) Stop and deterioration of patients and care is managed effectively. Pain mangement and severity of pain to be managed (pain scale measurement), how to help the patient.

3) Problem-solving, communication (MDT, families, relatives also), organisation, time management, Ability to delegate, medication management, decision making for the patients best interests (dependent on capacity to make their own deceisions), advocation, interpersonal skills (working with patients for person centred care).

4)Vital signs (NEWS chart), Capacitiy to make informed decisions, A-E assessment, Waterlow assesment (Skin inspection). Fluid input and output, falls assessment.

Physical assessment: Check her NEWSCORE. Body map checks such as bruises, moisture lesion, skin tear. Ask her if her periods are regular. Urine dip stick to identify any infection and pregnancy test as well.

Mobility: Assess her mobility for support or she is independent.

Medical history: Assess her previous medical history if she knows and any medication she is on. Ask about her allergies.

Family Connection: Ask about her family, if she is in contact with any of them.Ask her cultural background.

Urine and stool assessment: History of her bowel movement, when was her last bowel movement.

Food and Fluid, her intake and output to know her MUST score.

Substance abuse; since she is homeless, if she is taking any hard drugs and any alcohol.

Sleep pattern: How well she sleeps and her duration. If she is been abused sexually or physically.

• Active listening

• Clear and respectable

• Concise

• Appropriate body language

• Appropriate language

• Enagaging communication

• Open ended questions

• Emotional intelligence

• Non Judgemental

• Observant with patients behaviour and communication

• Cultural Awareness

• Trust

2) Main role of communication

• To understand one another

• Build relationships and ensure positive experiences

• Educating patients

• Provide safe and person centred care

• Expressing needs and wants (both from patient and nurse)

3)Four main methods of communication

• Verbal

• Non-verbal

• Visual

• Written

4)What good documentation should look like

• Should be clear and accurate

• Behaviour of a patient should be noted how they have slept, communicated,

• Detailed and concise information should be present

• Kept up to date in real time with the patient

• Patient medication rights and awareness of other mobidities.

• Cultural awareness detailling what the patient can and cannot eat (e.g a muslim patient will be halal or possibly vegetarian)

• Knowing the resuscitation status of the patient.

• Completing in line with the NMC code of conduct

• Safety and equipment checks (height of the bed, call bell in reach. patient using a wheelchair, if moving and handling required)

• Patient wishes and thoughts to be shared for person centred approach (answering a call bell was too long, patient could not close the window, extra blankets were required).

• Activites of daily living such as toileting, independence or dependence of care (opening bowels or passing urine).

• Noting any interactions with the MDT's and and outstandings tasks needing to take place.

Ways of making communication effective :

• Speak clearly and audible.

• Right tonation.

• Documentation

• Eye contact

• Active listening

• Conducive environment.

• Child friendly language

• Giving people time to process their understanding and retain information.

• Auditory aids in-situ.

• Clarify doubt.

• Interpreter

• Interacting with other people.

Four Main Methods of communication:

• Verbal Communication

• Non- verbal Communication ( Sign language,Braille)

• Visual communiaction ( pictures, flash cards, posters)

• Written

Best documentation practice

• Keep it clear and concise

• Be accurate

• Be consistent

• Relevance

• Legible

Ways of making communication effective :

• Speak clearly and audible.

• Right tonation.

• Documentation

• Eye contact

• Active listening

• Conducive environment.

• Child friendly language

• Giving people time to process their understanding and retain information.

• Auditory aids in-situ.

• Clarify doubt.

• Interpreter

• Interacting with other people.

Four Main Methods of communication:

• Verbal Communication

• Non- verbal Communication ( Sign language,Braille)

• Visual communiaction ( pictures, flash cards, posters)

• Written

Best documentation practice

• Keep it clear and concise

• Be accurate

• Be consistent

• Relevance

• Legible

• Airway

  Checking or observing any airway obstructions

• Breathing

  Patient is breathing comfortably with room air or oxygen and respiratory rate is within range

• Circulation

  Measuring the capillary refill time and patients colour of the patients skin is not pale or has cyanosis

• Disability

  AVPU, Glasgow coma scale and blood glocise montitoring

• Exposure

  Full body examination if required exposing the body

  
  

2) Observation for vital signs:

• Blood pressure (hypo 90/60, normal 120/80, hyper 140/90)

• Respiratory rate (12rr to 20rr)

• Pulse (60-100 bpm)

• SpO2 (equal to or more than 96)

• Temparature (36.1 - 38.0)

• Blood glucose if required ( 4.0 - 9.0

• Ketones if required (Below 0.1)

• Pain observation

• Opened bowels or passed urine

• Skin integrity

• Alertness or consciousness

• Fluid input and output

• Catherisation management

• Comfort levels

Scenario response

• Patient is scoring 7 which will need to be reported to the nurse in charge.

• The patient is required to be continously monitored.

• Oxygen to be administered through mask and levels monitored. Although patient is sitting try repositioning getting the patient to sit upright.

• Try to relax and clam the patient through reassurance.

• Give the patient fluid for hydration

• Find out when the inhaler was last admistered and how many puffs. How often have they been using their inhaler in the last few days.

• Evaluate external factors that can be effecting her

• Managing any pain if the patient has acknowledged this as a priority.

• Using relatives or significant person to communicate how they are feeling or medical history.

Observations which are part of vital signs are; from NICE guidelines

• Temperature - (36.5 -37.5 degree celcuis)

• Blood pressure- (120/80mm/Hg)

• Respiration rate-( 12-18)

• Heart rate (Pulse) - (60 -100 beats per minute)

• Oxygen Saturation -(95-100)

Situations;

She is dizzy, breathless becuase she has asthma,

Micheala should be placed on observation, review her medications and inhaler.

Give her inhaler to bring her breathing up.

Educate her on some activities which should not be done and lifestyle.

Educate her on her choice of diet and fluid hydration.

B- Breathing; patient in an upright position. Respiratory

C- Circulation; blood pressure reading.

D- Disability; anxious, pain, discomfort, movement , dizziness.

E- Exposure; temperature

• Ensure the surrounding are safe to complete any observations of the patient

• Checking the patients airway management for any obstruction, can the patient speck or is she wheezing and airway movment.

  
  

  B

  
  

• Acknoledgment of rr being 10 breathe per minute

• Checking the pattern of if it is fast or slow.

  
  

  C

  • Mottled skin

  • The pulse and documenting this.

  • Patient is pale

  • Recovery position if required

    
    

    
    

  D

  • Fingers responsive to pain

  • Check temperature to touch

    
    

  E

• If safe to do so and maintaining dignity and privacy complete a skin check

• Head to toe examination

  
  

  Other observations

  
  

• As a priority making the patient comfortable with pain management.

• Communicating all outcomes with the emergency services using the SBAR method for effective care and intervention.

• Checking pupil dilation for possible traumatic injuries.

  
  

• Ensure good sleeping pattern

• Social activities

• Family and friends support

• GP Prescription for anti depressant

• Counselling

• Behavioural chart to monitor.

• Social worker ( multi-disciplinary team to be involved )

• Detailed information of her personal life such as if she is single or have a partner.

  
  

  Baby

• Enough feeding for the baby

• Health visitor for frequent visits.

• if Katia is attending baby's appointments. such her immunisations,

•