Nursing Assignment: Review of Sally Brown Case and Phases of Slippery Slope

This nursing assignment reviews the case of Sally Brown, who suffered a head injury while skating without a helmet. The assignment discusses the four phases of the slippery slope and the nursing considerations at each phase. It also highlights moments of deterioration and the importance of critical thinking in patient safety.

Running head: NURSING 1
Nursing Assignment
Student’s name
University affiliation
Author’s note

NURSING 2
Introduction
The paper reviews the sally brown case. A young lady who was skating without their
helmet and hurt her head on the ground while performing a stunt. Through the paper, there are
two sections which need to be covered. First, a review of the slippery slope which contains four
major phases. The phases include prevention, what happened to the patient upon arrival to the
hospital and measures which were taken to reduce the pain or impact of the incident. Secondly,
the other phase includes a clinical review of the case study (Lund et al., 2011). What was
observed after tests were taken and the reason for occurring.
The third phase is on the rapid response, which mentions the condition of the patient and
why it is deteriorating. The final phase is the advanced life support, which mentions the type of
care which the patient receives and how it happened to have reached that stage (Jankovic, Le, &
Hershman, 2013). In all these phases, it is important to mention the registered nurse
considerations. The second section mentions the moments of deterioration and how critical
thinking can be used in each stage of the slippery slope. Finally, the article concludes by stating
what has been mentioned.
Section one: links scenario, BTF, and four phases of the slippery slope with underpinning
pathophysiology.
According to the scenario presented, the pathophysiology would be a head injury. The
pain from the injury is the threat to the patient’s wellbeing. Sally was a 15-year-old girl who was
injured while skating without a protective gear or a helmet. She was attended to 15 minutes after
the incident occurred by paramedics (Greaves, N., & Nicholson, 2011). In most cases, head
injuries are considered less serious. However, they constitute up to 80 percent of injuries which
are taken to the emergency department.

NURSING 3
1. Prevention phase
In this phase, there is continued treatment plans. For instance, on sally brown’s case, her
first treatment was administered when the paramedics arrived 15 minutes after the incident. She
was able to be observed on normal light while she was being transferred to the hospital (Lund et
al., 2011). On arrival to the hospital, she was examined and placed to a registered nurse, John
who was able to administer a neurological assessment and documented vital information about
Sally's case. Her Glasgow scale read 13 which, according to paramedics, is termed as mild. This
means that urgent attention is required (Ouaïssi, 2012). This can result in patient neurological
symptoms to be either permanent or temporary. It is advisable for a CT scan or MRI to be
undertaken for more evidence about the damage to be shown. This was one of the most
concerning observations.
Other abnormal observations which were made was the pain scale of 6/10. This showed
that the pain in the head was intense (Moll et al., 2011). Also, the Between The Flags system
(BTF) was used to avoid and protect the patient's conditions from deteriorating while unnoticed.
Also, it ensures appropriate care is applied to the individual. At this stage, nursing consideration
would be to ensure pain on Sally's head is reduced before it becomes horrible. Also, a CT scan
and MRI to be instituted to find more about the damage on the head.
2. Clinical review
In this phase, there are continued treatment pans which are administered to the patient. In
Sally's case, she was then transferred for a head CT, and her left temporal skull fracture keenly
looked at. She was then administered with 10mgIV metoclopramide, which would prevent
nausea while undergoing surgery (Dulucq, Wintringer, & Mahajna, 2011). Then she was
administered with 5mg IV morphine, which would reduce the pain in the head which she was

NURSING 4
feeling (Ahmed, Al-Shaikh, & Akhtar). Since she was only 15 years, 5mg was enough for her
immune to cope with. Lastly, she was administered with 10mg of PRN oxycodone, which could
relieve her from the pain. Considerations at this stage were to ensure Sally was feeling no pain at
all. As such, she was not allowed to be administered other observations.
3. Rapid response
In this phase, it contains a revised treatment plan. There are referrals to other doctors who
are made. A clinical pathway, either to admit the patient or provide appropriate treatment to the
patient, is offered (Gupta et al., 2011). This phase occurs after sally’s mother arrives, and she is
given a summary of what her daughter has been experiencing and what they have diagnosed her
against. Sally is given a room where she can rest and an afternoon registered nurse too. At this
point, sally is in the medical ward, where she is allocated a single room (Jankovic, Le, &
Hershman, 2013). However, the room is far from the nurse station. It shows the negligence of
such a serious issue.
At around, two in the afternoon, a few minutes after she is transferred to her ward, she
starts complaining about her head (Greaves, N., & Nicholson, 2011). Also, vomit is noticed in
her bed. For the revised treatment plan, she is administered with 8mg ondansetron IV, a slow
injection before she can be treated. She is also given 2.5mg IV Morphine, which should reduce
the pain in her head. After which, the nurse reassures the mother that they would attend to sally
in fifteen minutes after that intravenous injection is in her body (Moll et al., 2011).
Considerations here were that the medication would reduce the pain and improve her condition.
4. Advanced life support
In this phase, a patient is given high care unit and could be the need of life care too. This
is the death period of a patient. In Sally's case, she was administered with a nurse who took care

NURSING 5
of four stable medical patients. Two required hourly observation, while one was newly admitted
as Jane. Jane had undergone through the different flag stages and should have been given a nurse
without a patient. There was also a changeover at 4 pm, which meant another registered nurse,
Thomas would take care of Jane. At this period, Jane is unable to remember where she is at and
cannot identify herself. Also, she had vomited again. According to the report by Thomas, sally
recorder a Glasgow score of 9, which meant a moderate injury. Such a scale means that the
patient could have long-term impairment in thinking, physical, and emotional functioning. Other
observations are weird according to the mother, which prompts Thomas to call on the doctor as
soon as possible. Ten minutes later, Sally is either in a coma or dead as the mother tries to shout
at her with no response. Here, there is an urgent need for the doctor to attend to the patient.
Section two: Identifies moments of clinical deterioration to plan and justify nursing actions
Review the moments you have detected deterioration in the patient within the four stages of
the slippery slope.
1. Prevention phase
In this phase, moments of deterioration were noted upon arrival of the patient to the
hospital. While taking her to the hospital, the patient was still responsive. During the hospital
checks, she was found having an increased pain level, which was recorded as 6/10. The nurses
should have intervened immediately and administer painkillers drugs and also order a head CT or
MRI to know more about the head pain (Ouaïssi, 2012). Also, the Glasgow recorded a mild
reading of 13, which could have been attended earlier than the 15 minutes later according to the
records.
2. Clinical review.

NURSING 6
This phase also recorder some deterioration from the patient. This came about due to
negligence by the nurse and the doctors. For instance, instead of administering drugs, they could
have put the patient on scanning after which they could have treated them immediately. Instead,
they continued administering similar drugs, which proved no improvement.
3. Rapid response
After the CT scan, more treatment plans were offered to the patient. Additional drugs
only proved that the health condition of the patient was deteriorating. Despite vomiting being
prevented by administering 10mgIV metoclopramide, the patient filled her sheets with vomit.
This showed that the conditions were persisting (Dulucq, Wintringer, & Mahajna, 2011). Also,
the pain was noted as she touched her head while crying. At this moment, the nurses should have
ordered immediate surgery instead of administering more drugs. As such, their considerations
were wrong as at this point.
4. Advanced life support
In this stage, there were multiple conditions which showed how the situation of the
patient had deteriorated. First, the Glasgow score had reduced to a level of 9, moderate level.
This meant that the patient could have long-term impairment in thinking, physical, and emotional
functioning. Secondly, the blood pressure read BP 98/42mmHG, which was below the normal
conditions (Gupta et al., 2011). As such, the patient could be suffering from hypertension as her
blood pressure was reducing. The presence of minimal pupil reaction meant that the patient’s
body became irresponsive. They could be going to a comma, becoming unconscious or dying.
Lastly, they experienced shallow breathing of RR 8 (Ahmed, Al-Shaikh, & Akhtar). This meant
that blood was not being appropriately pumped to her entire body. At this point, the action was

NURSING 7
needed urgently. Thomas called on the immediate help of a doctor who after 15 minutes was still
unavailable. This cause the patient to either become unconscious die or fall to a comma.
As per results which were received from each stage of the slippery slope, it is evident that
the institution had negligent workers. This is visible from the first and second nurse and the
doctor’s behavior. Alternatively, the organization could be faced with a low supply of workers,
which should be considered in the future. Secondly, the organization is not keen on allocating
rooms to serious cases (Dasari, McKay, & Gardiner, 2011). As such, there is capacity building
needed to add on the number of rooms present. The patient had to wait for a room to be
preserved for them to be admitted to a ward. Lastly, treatment is delayed in that organization,
causing patients to recover slowly, die, or fall to commas. Also, it can be concluded that nurses
are not qualified from the decisions they make.
Consider why critical thinking and an understanding of patient safety is important when
recognizing patient deterioration.
For more than 50 years, nursing education has emphasized on the need to critically as one
of the essential nursing skills. Over the years, the definition has changed, and there are numerous
meanings of critical thinking (Collinson et al., 2012). It can be defined as the ability to regulate
self-judgment purposefully using cognitive tools such as analyses, interpretation, inference,
explanation, and evaluation. This centers in areas of methodological, conceptual, criteriological,
evidence, and contextual considerations.
In nursing, critical thinking is a necessity of professional accountability, which results in
quality nursing care. In most cases, critical nurse thinkers exhibit confidence, creativity,
innovativeness, open-mindedness, reflection, and perseverance. Ignorant nurses have proved to
lack critical thinking skills. This is evident in the case study provided about sally brown. Except

NURSING 8
one of the nurses, Thomas, all other medical practitioners, lack critical thinking skills. This can
be elaborated as visible in every stage.
In the first phase of prevention, Dr. Blaze, Dr. Rhodes, and John are very ignorant about
Sally's condition. After John had administered the tests, he was supposed to inform the doctors
about the results. Having a CT scan was one of the appropriate strategies one could propose.
However, after the scan, no appropriate action was taken. As such, it led to the second phase,
clinical review. More drugs were administered instead of patient health to be quickly taken care
of. Decisions made between the first and second phase were poor that they led to the third and
eventually, the last phase.
In the third phase, there was continuous vomiting and pain experienced from the phase.
Also, in the fourth stage, ore pain and other symptoms were visible. Despite one of the nurses
calling on immediate doctor’s help, negligence by the doctor made the sick girl to either die or
become unconscious.
Conclusion.
The entire article talks about the application of the phases of a slippery slope with the
underlying pathophysiology of the given case study. The case study is of a girl who while
skating hits her head hard on the ground. This causes certain complications to her, which have
been discussed in the article. The article also encompasses how the patient relates to the different
slippery slope phases and how the practitioners intervene to help her. As such, the study is
divided into two sections. The first section talks about the review of the case study and the four
phases, while the second part talks about patient monitoring and critical decision making.

NURSING 9
References
Ahmed, R., Al-Shaikh, S., & Akhtar, M. (2012). Hashimoto thyroiditis: a century
later. Advances in anatomic pathology, 19(3), 181-186.
Collinson, F. J., Jayne, D. G., Pigazzi, A., Tsang, C., Barrie, J. M., Edlin, R., & Marshall, H.
(2012). An international, multicentre, prospective, randomised, controlled,
unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic
surgery for the curative treatment of rectal cancer. International journal of
colorectal disease, 27(2), 233-241.
Dasari, B. V., McKay, D., & Gardiner, K. (2011). Laparoscopic versus open surgery for small
bowel Crohn's disease. Cochrane database of systematic reviews, (1).
Dulucq, J. L., Wintringer, P., & Mahajna, A. (2011). Occult hernias detected by laparoscopic
totally extra-peritoneal inguinal hernia repair: a prospective study. Hernia, 15(4),
399-402.
Greaves, N., & Nicholson, J. (2011). Single incision laparoscopic surgery in general surgery: a
review. The Annals of The Royal College of Surgeons of England, 93(6), 437-440.

NURSING 10
Gupta, A., Favaios, S., Perniola, A., Magnuson, A., & Berggren, L. (2011). A meta‐analysis of
the efficacy of wound catheters for post‐operative pain management. Acta
Anaesthesiologica Scandinavica, 55(7), 785-796.
Jankovic, B., Le, K. T., & Hershman, J. M. (2013). Hashimoto's thyroiditis and papillary thyroid
carcinoma: is there a correlation? The Journal of Clinical Endocrinology &
Metabolism, 98(2), 474-482.
Lund, J., Jenstrup, M. T., Jaeger, P., Sørensen, A. M., & Dahl, J. B. (2011). Continuous
adductor‐canal‐blockade for adjuvant post‐operative analgesia after major knee
surgery: preliminary results. Acta Anaesthesiologica Scandinavica, 55(1), 14-19.
Moll, F. L., Powell, J. T., Fraedrich, G., Verzini, F., Haulon, S., Waltham, M., & Schlösser, F. J.
(2011). Management of abdominal aortic aneurysms clinical practice guidelines
of the European society for vascular surgery. European Journal of Vascular and
Endovascular Surgery, 41, S1-S58.
Ouaïssi, M., Gaujoux, S., Veyrie, N., Denève, E., Brigand, C., Castel, B., & Nocca, D. (2012).
Post-operative adhesions after digestive surgery: their incidence and prevention:
review of the literature. Journal of visceral surgery, 149(2), e104-e114.