Problem
Prioritizing Patient Care
You arrive to your day shift on a busy General Internal Medicine Unit and receive report on your patients from the night shift RN.
• Patient I: Brooke Green is a 32-year-old patient, R1, who came in last night to ER and was found to be in DKA. They had been complaining of abdominal pain and vomiting over the last couple of days and were brought it by their partner, who had trouble waking them up after they watched movie together at home last evening. BGL on arrival was 27. The ABG was pretty bad, acidotic - you'd have to check though, I don't remember the numbers. Blood work was drawn at 0600 by lab. They've perked up a lot overnight - 15/15 GCS now, just complaining of some mild abdominal discomfort. No complaints otherwise. Last had some IV gravol at 0130. Afebrile. Heart rate has been 95-125 and BP 94/55 - 110/62. Foley catheter was put in while in emergency - I emptied it for you, urine has been clear and pale yellow. IV is running at 150. Insulin infusion running as well. I don't think they'll need to be here long.
• Patient II: Next door to them is Charley Poet, 67 years old, post-Covid pneumonia. They are an M1, came down from ICU yesterday. Extubated a few days ago, but still requiring really high O2 requirements. They have the Airvo on; respiratory was in there about an hour ago, but I didn't see them leave. Not sure if they made any changes. At my last assessment they were still running FiO2 60%, 35L, plus the non-rebreather is flush overtop. But just doing ok on it... Desatting to the mid-70s with only small movements and takes a few minutes to recover. They are supposed to have a repeat chest xray sometime this morning. Vitals have been stable otherwise, PPN is running until we can wean the oxygen down enough to go without the mask. Tolerated some ice chips overnight. I honestly don't know what the plan is for this one.
• Patient III: Finally, you have little old Francis Miller down the hall. Admitted 3 days ago after a fall at home . They have been super confused since arriving here. Oriented to self, but that's it. They are 89 years old, and they were admitted just 3 months ago for weakness and falls with lots of bruises and scrapes on their arms and legs. The family is thinking supportive living will be needed. Vital signs are stable, on room air. Pleasant, but frequently needs reorientation - keeps trying to get out of bed to go to "work"! The daughter has been at the bedside which is helpful. She's not there right now - just stepped out to get a coffee and a bite to eat, should be back in a bit.
Task
I. Consider each of your three patients. What other information would you want to know about each of them? What information is missing?
II. Who is your priority at this moment? Explain your reasoning. Who is you second priority?
III. Describe some ways that interdisciplinary collaboration will aid in the care of these patients.
IV. Using SBAR, IDRAW, or another structured handover tool - create an in-depth handover report if you were the nurse going off shift for your priority patient. What is the value in using structured patient handover tools?