Introduction to Specialty Nursing: Patient Assessment, Pathophysiology, and Nursing Notes

Running head: INTRODUCTION TO SPECIALTY NURSING
INTRODUCTION TO SPECIALTY NURSING
Name of the Student
Name of the University
Author Note

1INTRODUCTION TO SPECIALTY NURSING
Introduction
Mr. Dean Parker has experienced a sudden accident while driving his car in a high speed
and the car crash has affected the health condition of the patient. It has been seen from the
assessment of the vital signs and other observational data that the care process should consider
the consciousness of the patient (Canham et al., 2018). Moreover, the patient should be assessed
based on the consideration of the health condition improvement. The vital signs and the
handover of the patient would be assessed as well. Furthermore, the aspect of the care should be
considering the factor of the pathophysiology and the assessment of the patient. Hence, it can be
stated that the patient is in a critical condition and also the improvement of the patient would not
be seen very significantly. However, the assessment of the patient and the care process is
interconnected. Thus the proper assessment of the data found is required as there is no medical
history found. In the following section the assessment, pathophysiology and the nursing notes
considering the ISBAR handover chart would be discussed in details.
Patient assessment data
Following admission to the Emergency Department (ED), the patient was accessed for
checking and monitoring his vials according to which intervention strategies are to be planned. It
is important to conduct head to toe assessment in order to understand the patient’s condition
more comprehensively and accurately. It includes a detailed examination of the patient’s vitals
and addressing symptoms correlating with the current health status of the patient. Nurses
working in Emergency Departments must possess the skill set required to interpret and
understand the patient’s condition through thorough analyses, conducting assessments and
monitoring of their vitals (Toney-Butler & Unison-Pace, 2019).

2INTRODUCTION TO SPECIALTY NURSING
Prior to putting him on treatment, the objective data collected showed contusions and
bruises to his face and neck and his Glasgow Coma Scale gave the score of 7 with eyes 2, verbal
2 and motor 3, indicating his level of consciousness and the ability to respond. Although, no
skull fracture was palpable, cervical precautions were initiated. Evidences suggest that it is
important to initiate cervical collar in both pre and during the course of stay in the hospital to
prevent any further deterioration arising due to neurological weakening with spinal cord injury
(Aci.health.nsw.gov.au, 2019). Paradoxical breathing and a reduced air entry on the right side
was also noticed implicating weakening of the inspiratory muscles due to injury. Thus it can be
stated that the breathing rate of the patient is very much decreased due to pressure over the lungs.
Moreover, the blood loss due to the accident the blood pressure of the patient is also low. On this
context it can be seen that different doses of saline has been provided to the patient that will be
effective in the maintenance of the blood pressure of the patient. On the other hand the
medications are provided in this case has been seen to develop sedation and also pain relieve of
the patient as the primary concern for this patient is the pain. Other data that were collected
include deformity of his left forearm, shortening and external rotation of his right leg indicating
the severity of his wound due to injury.
Emergency nurses must access the patient’s condition properly and must be competent
enough to understand and comprehend what those signs implicates or interprets. This enables the
nurses to effectively manage and control the patient’s conditions by implementing the nursing
intervention strategies for an improved health outcome of the patients (Ghanbari et al., 2017). As
per the case study, the patient was accessed well and his vitals that were recorded showed heart
rate of 112 Sinus tachy, respiratory rate of 12 with air entry diminished on the right side, blood

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pressure of 90/50 indicating a very low blood pressure and his oxygen saturation was recorded as
86% indicating a lower oxygen saturation since the normal range varies between 96% to 99%.
His x-ray reports show that he was mildly comminuted impacted and an angulated
fracture of his right mid-shaft femur. His x-ray report also showed that he was having
comminuted fractures of the distal radius which are caused by trauma and they present as shear
and affects the fractures of articular surface of the distal radius by displacing the fractures. The
severity and pattern of the articular fracture is determined by the force of the injury, hand
position and carpal bone (Mader&Pennig 2006). Concomitant fracture of the ulnar styloid
process was found from the x-ray report. The proximal radius/ulna and elbow articulation was
intact. He was also found with the condition of flail chest which was caused by the breakage of a
segment of the rib cage resulting into trauma. It can also occur if 3 or more ribs are broken. It is
important to clinically diagnose and monitor fractures through x-ray since every patient who
have got fractures do not develop this condition (Perera& Daley, 2018). However, the patient in
the case study, had fractures both posterior and laterally to the right 2nd, 3rd, 4th and 5th ribs
causing a segment of the chest wall to move away characterized by significant respiratory
disturbances affecting the patient’s respiratory pathophysiology and can also lead to further
complications.
His peripheral pulses were present in all the four limbs. A peripheral pulse refers to the
high-pressure wave palpation of blood moving away from the heart through vessels in the
extremities following systolic ejection (Zimmerman & Williams, 2019).
His vitals also show ABG pH 7.21, PaO2 60, PaCO2 56, HCO3 22. It is important to
conduct assessment and monitor these vitals in the Emergency Department to monitor the acid
base balance of patients, gas exchange effectiveness and to understand in what state their