Nursing Case Study: Primary Survey and Discharge Planning

This nursing case study highlights the actions taken by a registered nurse during the time when the paramedics brought Corey Knight into the emergency ward. It also displays the primary survey taken by registered nurse under the algorithm of Airway, Breathing, Circulation, Disability, Exposure or Environment (A-E). Moreover, it demonstrates a clear discharge plan as he was shifted to an Orthopedic Ward after a femur surgery.

Running Head: NURSING CASE STUDY
NURSING CASE STUDY
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Author’s Note:

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The aim of this assessment is to highlight the actions taken by a registered nurse during
the time when the paramedics brought Corey Knight into the emergency ward. It will also
display the primary survey taken by registered nurse under the algorithm of Airway, Breathing,
Circulation, Disability, Exposure or Environment (A-E). Moreover, it will demonstrate a clear
discharge plan as he was shifted to an Orthopedic Ward after a femur surgery (Eltorai, Nguyen &
Daniels, 2015). Moreover, the surgeon also fixed an external device to his fractured femur,
which was detached after period of six weeks. Therefore, the nurses need to be extra careful
during the time of discharge as the external device was removed and he was on crutches. The
writing will also put an effort to incorporate several external factors to certify a collaborative
effort during the time of discharge.
Part-1: Primary Survey
The preliminary assessment and supervision of seriously injured Corey Knight was quite
challenging and nervousness tempting for many of the orthopedic surgeons. It required a special
orthopedic surgeon who had a good decision-making skill, clinical verdict and a systematic
approach of proceeding towards the surgery. In order to carry out the surgery, they proceeded
with a multidisciplinary team that included a medical team leader, airway supervision expert,
Anaesthetic associate, a common surgeon, an orthopedic expert, emergency physician, nurses, a
radiographer and a health management expert (Muñoz et al., 2014). It was a collaborative team
effort that helped the surgeons to carry out the surgery successfully with an utmost care and
appropriate management by the medical staffs.
During the time of emergency, the paramedics’ expert did a great job to bring Corey
Knight at the hospital. They strictly followed the writings as mentioned in the paramedic
handover, which signifies Identification, Medical criticism, Injuries related to complaint,

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Signs, Treatment, Allergies, Medications, Background of the medical history and other
concerns (IMIST AMBO). With respect to the handover, the advanced to carry the patient with
foremost confident and relevant information (Shah, Alinier & Pillay, 2016). The IMIST AMBO
protocol implicated two type investigations, the first one involved Ambulance paramedics and
the second one involved Emergency department clinicians. In both the situations, medical
experts were extra careful while carrying the patient towards the hospital. There was a concern
for the medical experts because his medical history was not available to them (Moloney & Batt,
2015). Although, the situation could have been critical for them, they did not bother about any
other concern and focused on their main priority to take care of the patient and travel towards the
hospital. Paramedic experts are also trained to provide help while taking the patient towards the
hospital in case of certain emergencies (Ogińska-Bulik and Kobylarczyk, 2015). Help include,
injecting painkillers if Corey could have been suffering from an unbearable pain, providing
oxygen masks or even medications in case of serious illness or sickness.
However, the nurses also monitored Corey Knight during the time of emergency with a
primary survey that implemented A-E algorithm. A-E algorithm mainly justifies the priorities of
nursing that elaborates to Airway maintenance, Breathing, Circulation, Disability and Exposure
control. In the given case study, the algorithm supports quite clearly and mentions a list of all the
nursing priorities (Monsieurs et al., 2015). Nursing priorities not only revolve around the A-E
algorithm but also gives a clear indication of beneficence, non-maleficence and autonomy
(Kangasniemi, Pakkanen, & Korhonen, 2015). The case study gives a clear idea how the nurses
faced the situation when Corey was brought to the hospital by the paramedic experts. With
respect to the situation and priorities, the nurses handled the situation quite carefully. The case
study elaborates that the patient was suffering from femur injury. In such case, doctors were

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mandate to perform Open reduction and Internal Fixation surgery, which was considered to
rebuild and alleviate a broken femur bone (Eltorai, Nguyen, & Daniels, 2015). Since, femur is a
huge bone; numerous trauma can cause severe damages to the bone. Surgeons follow two types
of surgery in order to heal the fracture completely. Open reduction allow the orthopedic surgeons
to relocate the broken bones into a proper arrangement whereas, closed reduction allow the
surgeons to relocate the arrangement of the broken bones by physical movements without even
going for open surgery (Chalmers et al., 2014). Nevertheless, in case of Corey, surgeons went for
Open reduction because there was an internal device that used to be fixed with bone (Leroux et
al., 2014).
Airway Maintenance is an emergency nursing care that requires an immediate health
expert to look at the patient’s condition. However, a minor negligence can cause the patient to
suffer permanent damage to his bone injury. Airway maintenance mainly look after the chest and
abdominal activities plus muscle respiration (Michálek & Miller, 2014). The priority highlights
two types of obstruction where thorough airway obstruction signifies no breath from mouse and
nose, the partial obstruction highlights breathing air becomes too much noisy (Lee, Kupeli &
Mehta, 2016). However, a severe bone injury in the case study could have caused depressed
awareness that could have led to permanent airway destruction. Treating airway obstruction as a
health emergency is the priority that nurses should follow (Coupaud et al., 2015). A patient
should be given immediate oxygen mask to prevent any kind of breakdown while respiration.
Such cases could lead the patient to hypoxaemia that increases the risk of permanent cardiac
arrest, kidney failure or even death. In the case study, it was severe femur injury. If remained
untreated, a pain in the bone could have definitely led to everlasting disability. One of the simple

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nursing strategy to follow during such cases is to provide Tracheal Intubation (Mushambi et al.,
2015).
Breathing is one the vital part of the algorithm as it assists the nurse to check heart rate
and respiratory rate. In case emergencies, it is necessary for the appointed nurses to check the
respiratory rate that might give a clear indication of the effectiveness of pain. In case if, there is
an increase or decrease in the respiratory rate then it might be give clear indication of effective
illness. Moreover, change in breathing pattern and excessive chest expansion is a clear warning
that the patient is suffering from immense pain (Pereira et al., 2015). However, in the given case
study when Corey Knight was admitted to the hospital in the emergency ward, it was vital for the
nurses to note the breathing rate and oxygen concentration plus the reading of SpO2 in the pulse
oximeter. However, the patient’s breath is also closely observed if in case the pain is unbearable
breathing rate fluctuates. The nurses also need to check the normal arterial oxygen that should
approximately 75 to 100 millimeters of Mercury (Hg). If the value is found to be below 60 mm
Hg then immediate supply of oxygen should be implemented. Breathing destruction can also
occur because of pneumothorax, which defines breakdown of lungs, that leads to leakage of air
between chest wall and lungs.
Circulation is the first priority that to be addressed in the algorithm because it allows the
appointed nurses to check the blood pressure in order to maintain the required flow of blood. In
most of the medical emergencies, hypovolemia is considered as the crucial reason of shock. Even
if patient’s blood pressure remain normal in certain cases but in most of the medical
emergencies, the blood pressure rises or lowers down (Anselmo et al., 2015). Similarly, as the
case study shows Corey Knight was suffering from injury in the femur bone and needed urgent
medical help. Therefore, there was a high possibility that blood pressure might have been

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increased, so, it was the duty of the appointed of the nurse to check the blood circulation
immediately. In case if, necessary nurse can use Intravenous Cannulae to ensure the maximum
flow of blood (Rosenberg & Christianson, 2015). It is also necessary to monitor the heart rate
and blood pressure after very interval of five minutes. After certain checks, if the blood
circulation does not improve then nurses should repeat the fluid flow or else ask for further
medical help. In the given case study, since Corey Knight was suffering from femur injury there
was no such report of low or high blood pressure. However, in certain cases if the patient is
suffering from some sort of chest pain the then nurses have the right to prescribe Aspirin orally,
Nitroglycerine in the form of drug or spray, Oxygen mask only if there is insufficient flow of
oxygen to an organ and morphine to avoid respiratory discomfort (Fejes-Szabó et al., 2014).
Moreover, it necessary to check the heart rate of the patient, usually a normal heart rate is
between 60 to 100, but incase of emergency it might rise to 120 or above. In such cases
immediate beta blockers such as Metoprolol, propranolol and atenolol.
Disability is a part of the algorithm that is highly relatable to the case study. As the
patient suffered from serious injury Femur bone. Therefore, there is a possibility of Corey Knight
suffering unconsciousness that include cerebral hypoperfusion, hypoxia and hypercapnia. Most
of the unconsciousness justify insufficient flow of oxygen and carbon dioxide to the tissues
(Devleesschauwer, 2014). According to the case study, the patient’s pain would give a high
probability that there was insufficient flow of oxygen due to which there was increase in the pain
that the nurses needed to address. However, in such cases nurses need to check the blood glucose
using the finger-prick method to check hyperglycemia. In case of a diabetes mellitus patient, if
the blood glucose level is low enough for an unconscious patient, the nurses need to give an
external dose of glucose intravenously (Yan, 2014). If required, there is an order to give further

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dose of glucose until the patient regain consciousness. The section also covers if the patient is
suffering from some form of neurovascular disease. In such case, it is mandatory to check the
pupil and also to keep a close eye on his consciousness.
Environment/Exposure is also a priority that needs to be taken care. It is very important
from the nursing perspective to provide a proper environment and exposure to the patient. If in
case, the patient is suffering from any kind of severe injury or accident, then he needs a safe
environment in order to get rid of bacterial infections. Similarly, in the case study, as the patient
was suffering from an injury in the femur bone and required urgent care, therefore he was taken
to an orthopedic ward so that doctors could analyze and evaluate his condition (Pierpont et al.,
2014). Being a nurse, it is mandatory for them to analyze the situation and follow a proper
judgment. A minor negligence can lead to a major destruction. Moreover, any intravenous fluids
or blood that to be administered should also be taken care off because if the blood is exposed to
an environment, there will be high prospect that bacteria can affect the blood (De Vries et al.,
2017). Moreover, the case study showed that Corey Knight had an orthopedic surgery, so the
nurses also took utmost care to keep the surgery room free from bacteria and infections.
Environment is a priority of the algorithm that comprises to keep the surgical equipment free
from bacteria and must be properly sterilized.
Part-2: Discharge Planning
Discharge planning was done quite critically as there was an external device fixation
which lasted for six weeks. Before certifying the discharge, nurses made sure that he his injuries
were properly healed and multidisciplinary team certified the discharge. His surgery involved a
group of surgeons, nurses, physicians and a scribe. Therefore, in order to certify a discharge
every health experts must be sure that he was on the way to recovery. Moreover, certain

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biological, psychological and environmental factors played an important role (Berian et al.,
2016).
Biological factors that involved his overall health condition because after six weeks it
was obviously tough for him to get back to his regular schedule. He needed some time to walk
properly as it would take a period to heal the internal wounds and to come out of that trauma. It
would also be necessary for the nurses to check his internal conditions such as blood pressure,
heart rate, respiratory rate and blood glucose (Lu et al., 2016). His internal wounds were the
biggest concern because he got his external device removed and it would take some time to heal.
Psychological factors also played an important role to influence Corey’s life after such a
trauma, it would be quite difficult for him to get back to his normal life and he might suffer from
depression and anxiety for some period as prescribed by the team of doctors. Post-traumatic
stress may impact Corey’s mental health status and may cause Corey to suffer from stress,
anxiety, fear and anger. Mental health illness could change his relationship with his family and
friends. There could be certain times when he would require proper counselling from a
psychologist regarding his circumstances and the registered nurse should refer a psychologist
(Reynders, Kerkhof, Molenberghs & VanAudenhove, 2014). Walking properly would require a
lot of effort and time that might lead to some form of depression, as he would not be able to
follow his schedule. However, in such cases his family needed to be strong enough to support
him emotionally and morally. They should provide definite time and counselling for the
development of his mental health as well.
Certain environmental factors that could be responsible during his time of discharge
such as pollution is a matter of concern as per the doctors’ suggestion. They made sure that the
wounds and injuries should not be exposed to polluted environment, as there would be high

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chance of infection from the bacteria present all around. Doctors clearly stated that bacterial
infections are quite common in case of unhealed wounds and surgical cuts. Wounds must be
healed properly or else Corey might suffer from nerve damage, blood clotting, bleeding or even
irritation due to bacterial infections (Lewis et al., 2016). However, in further progress the
registered nurse must refer a general physician if in case Corey suffer from any form of
infections.
Moreover, sociocultural influences are much stronger than the others are. Corey’s
surgeries may stop him from accompanying his typical daily happenings such as way to the
shops or church, appearing communal proceedings or meetings. It might happen that Corey
suffer a distress of walking meanwhile the happening which would also have an influence on her
everyday routine. Keeping an immense effect on Corey’s lifetime may cause Corey to develop
lonely and reserved. The registered nurse would want to have deliberations with Corey and his
family in respects to supporting Corey with her social and cultural needs while upholding
Corey’s morals, self-respect and individuality (Eroğlu, Ataoğlu & Küçük, 2017). The registered
nurse would discuss Corey to a communal operative who would be able to support Corey with
transportation and municipal amenities in order for him to appear locations or proceedings that
would be significant to Corey in order for him to preserve himself value.
Few of the Politicoeconomic factor that influenced Corey’s life. Corey’s period
consumed in hospital would have intended that Corey would not have been able to go to work
which may see Corey fronting monetary complications. Corey’s admission to hospital might lead
him to lose his job and not being paid a revenue (Namdari et al., 2014). The registered nurse
would want to deliberate that Corey might no longer have an automobile and might not be able
to have enough money to get his car secure because of the absence of salary. Not getting a

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revenue would keep Corey under monetary and corporal pressure which could source Corey to
sense overawed with the supposed of not being able to receive an salary and wage his bills. A
communal operative would be mentioned to Corey to support his with the capability to be clever
to wage for essential belongings such as medicine and housing by connecting his services such
as connectivity and public covering facilities (Snider et al., 2017). Connecting Corey up to
suitable capitals would support to contribute in Corey’s strength not being negotiated.
Lastly, a conclusion can be drawn from the above writing, evaluating a patient that has
offered to the emergency section needs numerous valuations, which need a primary, subordinate
and attentive valuation. The difficulties and matters that individuals face while admitted to the
emergency section differ and needs the registered nurse to have exceptional critical intellectual
and medical cognitive assistances. The registered nurse must be able to combine the individuals’
past with valuation answers to regulate the suitable nursing involvements and the step of
perseverance in which the involvements must happen.

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