Scenario: Mr Johnson is a 57 yo male that admitted to your unit from the emergency department last night c/o increasing SOB and inability to lie flat in bed and has been sleeping in a recliner. He states he has not been able to wear some of his shoes due to his feet swelling. He has a history of Hypertension, Diabetes type II, A fib, Hyperlipidemia. EF 45%. He lives with his wife of 35 years. You have completed receiving report and make rounds on your patient. The following are his vital signs the HSA has reported to you. BP 162/54, HR 120, T 98.6(oral), 02 sat 91% on 1L nasal cannula., Resp. rate 24/min.
You go to his bedside and find him mildly diaphoretic, RR 28/min and using accessory muscles. His heart rate is 124/min and irregular. He is alert and oriented but states he feels a little anxious. He has voided a "small amount" per the CNA via urinal. His morning labs Troponin is 0.10 ng/ml, BNP 1725 pg/ml, (previous BNP 455 on admission), Na +138, K+3.2, BUN 45, Creat 1.9, CL 98, CO2 22, Gluc 127.
Orders include: Titrate 02 to keep sat>92%, Lasix 40 mg IVP BID, due at 0800, (It is 0745). ASA 81 mg daily. Strict I&O, 2 GM sodium diet, carb controlled diet.
What steps will you do first and why?
What other pertinent data (including assessment) would you need/like to collect prior to "calling" and why?
What types of findings would you expect to see or be absent?
What types of disorders could cause those values? Need Assignment Help?
Give two examples of potential adverse outcomes that can occur when there is a breakdown of communication amongst the care team. Breakdowns in communication includes failure to report important test results, not informing the correct person, delays in communication, etc.
Describe how your ISBAR would differ from shift report, SBAR to another department assuming care of patient such as OR , Cath lab, vs. an ISBAR to the HCP.(describe the differences with an example for cath lab)
Utilizing the ISBARR (Introduce-Situation-Background-Assessment-Recommendation-Readback) communication tool to call and inform a provider (MD, DO, NP, etc) of an abnormal lab value or assessment finding. You will decide what you are concerned about to call HCP about given scenario, such as vital signs, uop, lab etc. For missing data(yes, several things are left out that you would need to assess...) you may "add" those findings that you may expect to find.