HSNS338 Neurological Case Study Assignment

Instructions: This is an individual assignment.

Length: 1000 words

Task:HSNS338 Neurological Case Study Assignment

Read the case studies below, choose one case study to discuss by answering the associated questions. You do not need an introduction or conclusion and headings are advised. You must use academic writing and reference your work using APA referencing. Your ISBAR may be presented in table form. Please do not use bullet points, use well-structured paragraphs and ensure you have edited the text.

Case Study 1: Neurological

Miss Emily Corathers has just celebrated her 21st birthday, for her birthday her parents gave her a new car, it was this car she was driving when she collided with a car at an intersection on her way into town. There was side impact with a large deformity to both cars. There were no fatalities, Emily sustained a full thickness laceration approximately 5cm long on the occipital region of her head, she has scratches to her face and neck and a possible head injury, she has a GCS of 14/15. She is c/o a headache and has vomited once on scene. Her observations are as follows:

• Temperature: 36.2
• Heart rate: 105 bpm
• BP: 110/70
• RR: 18 breaths per minute
• SpO2: 97% on 6L via a face mask
• GCS 14 (E=4, V=4, M=6)

Blood is taken for FBC, EUC, lactate, glucose and blood group and hold. A 12 lead ECG is performed, a 14g IVC inserted into her right cubital fossa. A provisional diagnosis of a Base of skull fracture with extradural hematoma is made. While in the Emergency Department Emily is referred to the neurology team for a consultation. It is decided by the neurology team she will need surgical intervention and therefore, need to be transferred to the appropriate tertiary facility. The retrieval team is contacted but it will be a number of hours before they will be there as they are busy at present. Therefore, Emily will remain in the Emergency Department under close observation until the team arrives.

• Temp: 36.2
• HR: 110 (sinus tachycardia) bpm
• BP: 110/60 mmHg

Questions

1. Identify the elements which signify a deterioration in this patient’s condition. Identify whether these elements of deterioration indicate a rapid response or a clinical review as per the NSW Health Between the Flags. Justify your decision with the data from the case and relevant support.

Case Study 2: Cardiac

Mr. Jae-Kwang Lee, a 65-year-old male who presented to the Emergency Department stating his chest felt heavy. At the triage desk he was holding his chest, when asked if the heaviness went anywhere he said yes and then proceeded to rub his left arm. When questioned further during the triage process he had associated symptoms of shortness of breath and dizziness. He had not had pain as severe as this before, he said he “has been having pains in his chest for a few months but it stops when I sit down, but it didn’t stop this time, I have been waiting for it to stop, it started yesterday”. Mr. Lee was taken into the Emergency Department and connected to cardiac monitoring, a 12 lead ECG was taken which showed a Non-ST-elevated Myocardial Infarction (NSTEMI). His first set of observations are as follows:

• Temp: 36.5
• HR: 110
• BP: 108/73
• RR: 21

Mr. Lee also had blood tests taken including UEC, FBC, CK-MB, Trop T, Coags. Mr. Lee was also given sublingual GTN for pain 300mcg x2 – 5 minutes apart without effect, he was then given morphine 5mg, in 2.5mg increments with effect. 2 hours into your shift, you are assessing Mr. Lee and note that Mr. Lee has become tachycardic, hypotensive and hypoxic his observations are as follows:

• Temp: 36.5
• HR: 133
• BP: 87/53
• RR: 25

Questions:HSNS338 Neurological Case Study Assignment

1. Identify the elements which signify a deterioration in this patient’s condition. Identify whether these elements of deterioration indicate a rapid response or a clinical review as per the NSW Health Between the Flags? Justify your decision with the data from the case and relevant support.
2. Using a table construct your communication with the Doctor regarding this patients deterioration employing the ISBAR tool [this section does not need to be referenced].