Clinical Handover and Discharge: A Case Study

Running head: CASE STUDY 1
Case Study
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CASE STUDY
Case Study
Introduction
Today, clinical handover has become an integral tool in healthcare operations.
Patients’ safety and treatment rely majorly on the finer details that are passed over from one
clinical professional to the other. Therefore, any communication breakdown between the
emergency staff and the paramedics can be detrimental to the safety and well being of the
admitted patient. It is, therefore, necessary for a registered nurse to make use of the
information handed over by paramedics to effectively assess the state of the injured patient.
However, this process should be conducted based on the stipulated clinical standards. This
involves scrutinizing the ECG records, pocket contents and the general information
captured in IMST AMBO during handover. This paper will seek to examine all the factors
involved during handover and discharge. This will involve evaluating Corey’s case through
the A-E nursing algorithm and the relevant case responses. Also, the paper will propose a
holistic approach that can be adopted by a registered during Corey’s discharge.
Primary Survey
At the outset, the primary survey on a critically injured patient is usually governed
by similar principles. The need to stabilize a patient irrespective of the inflicted injuries is a
priority for every nurse working in the emergency department (Shah, Alinier & Pillay,
2016). It is with this reasoning that the A-E algorithm was introduced in the primary survey
of patients (Bjurman, Mangafic & Holzmann, 2018). This protocol aims to ensure that a
registered nurse resolves all life-threatening risks before a patient undergoes other stages of
assessment.
Airway
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CASE STUDY
The main objective of this assessment criterion is to ensure that a critically injured
patient does not suffer from air blockage or any other constraints in the respiratory system.
In the case of Corey Knight, a registered nurse should prioritize assessing for any signs of
airway obstruction on the patient. This may include checking for paradoxical chest
movements, breath sounds, tracheal fractures, and the presence of different obstacles in the
patient’s respiratory system.
The handover information from paramedics is crucial for the success of the airway
clearance procedure. Usually, this process requires little time since the life of an injured
patient is at stake (Kalyani, Fereidouni, Sarvestani, Shirazi & Taghinezhad, 2017).
Therefore, IMST AMBO serves as a guide through which a registered nurse uses to
accurately determine the leading cause of airway blockage in a patient. As mentioned by
Shah et al. (2016), the IMST AMBO captures the injuries, history, medications, allergies,
signs and symptoms, among other characteristics that identify the patient. Hence, a
registered nurse will carefully look for thigh or leg deformities, bruises on the skin, and
associate the sustained injuries to airway obstruction tendencies.
Adverse Femur injuries are usually associated with excessive blood loss and pain,
which can result in depressed consciousness. In such an event, a registered nurse should
prioritize categorizing the airway obstruction as a medical emergency where high-
concentration oxygen amounts are administered to the patient via a self-inflating bag.
Moreover, the clinical officer in charge has to make use of the patient’s history to determine
if Corey is fit for surgery or non-surgical treatment. Since the paramedics did not have any
historical data regarding Corey’s health condition, surgery is the only viable cause of action.
Breathing
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CASE STUDY
The main objective of this assessment criterion is to ensure that a critically injured
patient adequately exchanges gases without restrictions. Airway clearance on its own does
not guarantee adequate ventilation. Usually, a regular gaseous exchange is associated with
the proper functioning of the lungs, diaphragm and the chest wall (Silverthorn, 2015). In the
case of Corey, a registered nurse should prioritize examining for central cyanosis, excessive
sweating, and the overall breath sound produced by the patient (Hough, 2013). However,
this process should be guided by the information captured by paramedics during handover.
It is through the historical data obtained in IMST AMBO that serves as a guide in
determining if a patient has ever suffered from pulmonary oedema, asthma, massive
haemothorax or tension pneumothorax.
Since paramedics did not have adequate information about Corey’s health history, a
registered nurse needs to examine for the presence of respiratory system related illnesses
that Corey may harbour. In this case, a registered nurse should recommend for oxygen to be
administered to Corey for stable ventilation. Also, considering that Corey sustained a
broken femur, administration of oxygen serves as a means of restoring energy required for
the next stages of injury assessment.
Circulation
Control of hemorrhage and cardiac output are the main priorities in this clinical
assessment criterion. Corey is considered to suffer from a broken femur; hence, an adverse
hemorrhage is likely to occur. Mostly, bleeding can both be internal or external, depending
on the damage caused by the tissues surrounding the broken bone (Tinubu & Scalea, 2015).
If the blood loss is excessive, a patient is likely to suffer from hypovolemia which
consequently leads to death.
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