A-G Assessment: Patient Evaluation and Care

A-G assessment:
A Airway is Patent, nil of obstruction. Patient able to talk in full sentence.
B Spo2 97% in RA. RR 22 normal and strong. There are no signs of wheezing or stridor on
escalation. No any sing of respiratory distress noted.
C Bp 124/80 mmHg. HR is 108 bpm which is regular and strong. His capillary refill >2
second. His hand warm to touch. no any sign of cyanosis present.
D Patient conscious and oriented. Pain scale is 0/10. Pupils is reactive to the light.
E Temp 37.5 degree Celsius. No IVC. Nil of oedema. There is no wound or injuries. No any
chest tube or IV inserted.
F No current IVf running. His intake is 2L of orange juice and 4 glasses of water. He noted
that he has been to toilet and did a big wee.
G BGL 21.2 mmol/L, which indicate hyperglycaemia. No sign of confusion.
ISBAR:
I: Hello X (name of senior nurse). My name is Deepana,I am a student RN. Is this Dr-Y? I am calling
from MMW about Mr Jo French, 45 years old in room 5 who was admitted to the ED.
S: I am calling for clinical review for Jo French as per the Clinical Emergency Response System (CERS).
The patient has hyperglycaemia. He is experiencing of some blurred vision increase frequency of
urination, thirst, hunger, fatigue and dizziness which indicate the hypoglycaemia.
B: Jo French is a 45 years old patient who was admitted to ED due to fall in his bathroom overnight
and hits his head but no loss of consciousness. He has no significant medical history, from the past
but his father has a history of heart disease. He was experiencing dizziness, blurry vision, weakness
and nausea before his fall.
A- Airway is Patent, nil of obstruction. Patient able to talk in full sentence.
B- Spo2 97% in RA. RR 22 normal and strong. There are no signs of wheezing or stridor on escalation.
No any sing of respiratory distress noted.
C- Bp 124/80 mmHg. HR is 108 bpm which is regular and strong. His capillary refill >2 second. His
hand warm to touch. no any sign of cyanosis present.
D- Patient conscious and oriented. Pain scale is 0/10. Pupils is reactive to the light.