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The Story

It is Friday the 13th and a full moon. You are an LPN who normally works on a medical-surgical unit, but your unit is overstaffed, and the emergency department is short-staffed. The nursing supervisor asks for a volunteer to go down to be an extra pair of hands. You volunteer.

When you get to the ER, you are asked to take vitals on a client in the trauma room. The client is a 24-year-old male who was stabbed multiple times in the abdomen. The wounds appear superficial, and the client has been stable thus far. He will be going to a CAT scan as soon as they can fit him in. You approach the client, who appears slightly pale with cool, clammy skin but is alert and talkative. The vital signs are:

- Temperature: 97.3 (PO)
- Pulse: 115
- Blood Pressure: 95/54
- Respiratory Rate: 24
- Pain: 6/10

You notice the client voided 100 mL of tea-colored urine in his urinal.

One hour later, the client becomes unconscious. His pulse is now 144, and blood pressure is 70/50. The client is taken to the OR and has a nephrectomy for a very damaged and bleeding right kidney.

Answer the following questions:

1. What were the clues in the data collection that should have alerted you and the staff that there might be a problem? (5-10 sentences)

2. Why is the urine "tea-colored?" (one sentence)

3. What are some other interventions that could have been done? (2-5 sentences)

4. Was the LPN in this scenario working within the scope of practice for an LPN? Why or why not? (5-10 sentences)

5. How did the environment of care (busy ER) contribute to the client’s deterioration? (5-10 sentences)

Answer :

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Final answer:

In a trauma scenario, changes in vital signs, such as a decrease in blood pressure and an increase in heart rate, should have alerted the LPN and the staff that there might be a problem. The tea-colored urine observed in the client's urinal could indicate the presence of blood and should have raised concerns. Prompt communication with the healthcare provider and interventions, such as IV fluid administration and immediate transfer to the operating room, could have been done to address the deteriorating condition. The LPN was working within their scope of practice, but prompt communication with the healthcare provider was necessary. The busy environment of the emergency room can contribute to delays in assessment and interventions, potentially worsening the patient's condition.

Explanation:

Assessment and Interventions in a Trauma Scenario

In a trauma scenario, accurate data collection and interpretation are crucial for identifying potential problems and providing appropriate interventions. The vital signs, including temperature, pulse, blood pressure, respiratory rate, and pain level, serve as essential indicators of a patient's condition. By closely monitoring these vital signs, healthcare professionals can detect changes that may signal a deterioration in the patient's condition.

In this case, the initial vital signs of the 24-year-old male client who was stabbed multiple times to the abdomen were within normal limits. However, one hour later, the client became unconscious, with a pulse of 144 and a blood pressure of 70/50. These changes in vital signs should have alerted the LPN and the staff that there might be a problem. An increase in heart rate and a decrease in blood pressure can indicate hypovolemia or internal bleeding, which could be life-threatening.

The tea-colored urine observed in the client's urinal is another clue that there might be a problem. Tea-colored urine can indicate the presence of blood in the urine, which could be a sign of kidney injury or bleeding. This finding should have raised concerns and prompted further investigation and intervention.

Some other interventions that could have been done include:

  2. Notifying the healthcare provider immediately about the changes in vital signs and the tea-colored urine to ensure prompt evaluation and intervention.
  4. Starting intravenous (IV) access to administer fluids and replace any potential blood loss.
  6. Monitoring the client's urine output closely to assess for any further changes in color or volume.
  8. Preparing the client for immediate transfer to the operating room for a nephrectomy, as indicated by the damaged and bleeding right kidney.

Regarding the LPN's scope of practice, it is important to consider the specific regulations and guidelines of the state and facility in which the LPN is practicing. Generally, LPNs work under the supervision of registered nurses (RNs) and are responsible for providing basic nursing care and assisting with certain procedures. In this scenario, the LPN's role in performing vitals and assisting in the trauma room aligns with their scope of practice. However, the LPN should have promptly communicated the changes in vital signs and the tea-colored urine to the healthcare provider for further evaluation and intervention.

The busy environment of the emergency room can contribute to delays in assessment and interventions, potentially worsening the patient's condition. In a busy ER, healthcare providers may be overwhelmed with multiple patients and competing priorities, leading to delays in recognizing and addressing changes in a patient's condition. In this case, the client's deterioration may have been exacerbated by the time it took to transfer him to the operating room for the necessary nephrectomy.

Learn more about assessment and interventions in a trauma scenario here:

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