Scenario 1
Mrs Chan is found lying at the bottom of her stairs by her daughter at 09:00 on 14/06/2016. Mrs Chan is dressed in a nightgown; the last thing she remembers is rushing to the toilet at about 10pm. She has no memory of falling, she recalls “waking up” on the floor feeling cold because she was incontinent and her night gown was wet. She was unable to get up due to a penetrating wound to her left leg from falling on a glass coffee table that has broken and become embedded in her upper thigh. She also has pain in her hip and pelvis. Her right leg is shorter than the left and it is internally rotated.
Mrs Chan’s past medical history includes:
• Urinary incontinence
• Osteoporosis
• Compression fractures to her spine due osteoporosis
• Chronic pain
Regular medications:
• Fosamax
• Vitamin D
• Calcium
• Fentanyl patch
• PRN endone
Question 1.
Describe the initial assessment of Mrs Chan, including the following points in your answer:
(a) Describe the process of completing a primary survey on Mrs Chan
(b) List the specific assessments that would assist you to evaluate her penetrating injury.
Question 2.
Review the vital signs chart (attached pdf) and evaluate the following aspects:
(a) List each of the vital signs recorded at 06:30 in the table below:
List the vital sign
Respiratory Rate
O2 Saturation
O2 Flow Rate
Systolic BP
Heart Rate
Temperature
4 Hour Urine Output
Consciousness
(b) Complete the ADDS score for each vital sign recorded at 06:30 in the table below, then total the ADDS score.
ADDS Score
Respiratory Rate
O2 Saturation
O2 Flow Rate
Systolic BP
Heart Rate
Temperature
4 Hour Urine Output
Consciousness
Total ADDS
(c) List the abnormal signs and then describe the abnormality using correct terminology.
Further Information
Mrs Chan is seen by the doctor, who documents her assessment as follows:
• 82 year old lady with confusion and hypothermia.
• Air entry R=L no adventitious sounds.
• Large laceration to her right thigh, glass remains imbedded in the wound.
• Right leg has obvious bone deformity – requires further investigation to evaluate possible fractures.
A chest, abdominal, pelvis and hip X-ray are to be completed. Intravenous normal saline 1L is prescribed to run over 4 hours
(d) Note the ‘Actions Required’ section of the ADDS chart and explain who should accompany Mrs Chan when she leaves the ward to go to the X-ray department. You would need to ensure that you confirm this with the RN.
Question 3
Mrs Chan has been prescribed an IV solution of normal saline, which contains sodium chloride and water.
(a) Explain the following concepts related to body fluid compartments and intravenous fluids:
(i) Define the terms solute and solvent and how it relates to the prescribed solution
(ii) In your own words, explain what osmosis is and how it works in the three fluid compartments of the body
(iii) Why is Mrs Chan’s IV fluid an isotonic solution?
(iv) Why this solution is used to treat dehydration?
(v) Correctly match the terms listed below to either Active or Passive transport:
• No energy required
• Osmosis
• Endocytosis
• Requires energy
• Diffusion
• Sodium-potassium pump
Active Transport Passive transport
(vi) Describe the difference between hydrostatic pressure and colloid osmotic pressure (also known as oncotic pressure) in relation to transport of fluids across a capillary membrane.
