HLBN621B Case Study: Emergency Nursing Care of Patient Flora

This case study workbook focuses on the emergency care of a 35-year-old female, Flora Jones, who was involved in a high-speed car crash. It details the initial nursing assessments in the Emergency Department, including vital signs and triage using the Australasian Triage Scale, and the Glasgow Coma Scale. The study covers diagnostic tests like CT scans and MRIs, and the differences between internal and external fixation of fractures. It also addresses the patient's medical history, including depression and type 2 diabetes, and the impact of trauma and stress on blood glucose levels. Furthermore, the case study explores the therapeutic uses and pharmacological actions of medications such as fluoxetine, morphine, and ondansetron, alongside the nursing responsibilities for their administration. The assignment is designed to enhance understanding of nursing practice management in acute and complex care settings.

Running head: CASE STUDY WORKBOOK
WORKBOOK FRAMEWORK ON A PATIENT’S CASE STUDY
Name of the Student
Name of the University
Author Note

1WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Flora Jones is a 35-year old female that has been brought into the Emergency Department
(ED) following a high-speed car crash. She was hit from behind travelling at 100 kilometres
per hour. She was wearing a seat belt and was trapped in the car for 45-minutes before being
cut out by the fire service and brought into ED by ambulance. She is immobilised in a hard-
collar and backboard.
In order of priority, what nursing assessments might the triage nurse conduct? Provide a.
Explain the process of triage and what physiological parameters the nurse may use to assign a
triage code.
On examination in ED Flora has a large laceration over her left temporal area and abrasions
across her chest and abdomen from the seatbelt she was wearing. She is complaining of pain
over her hips. She is opening her eyes to voice, is confused and is localising to pain.
What is Flora’s Glasgow Coma Scale (GCS)?
1
At first, the nurse might also check the patient’s vital signs such as blood rationale for
your choices pressure, cardiac output, and heart rate. She might take the patient in trauma
care. Trauma care provides all types of emergency facilities starting from orthopaedic
surgery, brain injuries, and spinal injuries to critical care. Since she was wearing a seat
belt for 45 minutes, the nurse might suspect that the patient might have collarbone
fractures or major spinal damages. The triage nurse might perform some imaging tests
like MRI, CT-scan to examine any injury and also the Glasgow Coma Scale Test to
analyse the motor response, eye response and verbal response of the patient.
The triage system is the prioritization of treatment procedures on the basis of severity of
the patient condition. This triage provides patient treatment efficiently when the resources
are limited and treatment should be served promptly. The nurse may consider the factors
such as Glasgow coma scale score, respiratory rate and blood pressure to form a triage
code.

2WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Flora’s vital signs are:
Blood Pressure: 110/50 mmHg
Heart Rate: 110 beats/minute
Respiratory Rate: 24 breaths/minute
Oxygen Saturations: 98% on room air
Temperature: 36.4˚C
Glasgow Coma Scale (GCS) 4 (verbal response), 3(eye response), &
5(motor response)
The nurse assigns Flora a Triage Code Two using the Australasian Triage Scale (ATS).
Explain what a Triage Code Two means and why the nurse would have assigned this code.
2
Triage code two defines the treatment procedure where the patient requires an immediate
treatment within 10minutes. This condition is referred to as imminently life-threatening
event. The Australasian Triage Scale is a medical device to identify highest waiting time
for therapeutic evaluation and care process. It also helps to assign the patient in
emergency department in accordance with the urgency of their condition. In this case, the
nurse might assign this code because the patient may suffer from critical illness and might
have severe fractures or pain. Hence, under this code the patient may get the immediate
treatment against her illness.

3WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Describe what diagnostic tests may be conducted as part of Flora’s initial assessment. Provide
a rationale for your answers.
Initial radiological assessments reveal that Flora has no spinal injury or fractured ribs, but she
does have unstable bilateral fractures of her pelvis. Flora is transferred to an orthopaedic
ward to wait for surgical stabilisation of her fractures.
Explain the difference between internal fixation and external fixation of fractures
3
After primary assessment of Flora, some diagnostic tests may be followed. The nurse
may refer to CT scan or MRI to analyse any muscle tears, fractures, organ damages, and
spinal injuries other tissues. X-ray is done to examine any soft tissue damages.
Internal fixation of fractures refers to the surgical method that stabilizes and joins the end
of fractured bones using automated tools like screws, metal plates, wires, pins. In
opposite, external fixation performs as stabilizing setting that is used to clamp the broken
bones in proper position. Internal fixation differs from external fixation by a splint or cast.
In an external fracture, the screws or pins are positioned into bone through small cuts into
the muscle and skin. The exterior fixation is mainly focused on short-term care process of
cracks.

4WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Once on the ward further assessment reveals that Flora identifies as Maori and she shares a
house with her long-time partner, James. Flora lives in a rural area and has a job as a medical
doctor working in pathology. She has a previous medical history of depression and type 2
diabetes and is prescribed glipizide 5mg/daily; quinapril 10 mg/daily; simvastatin 20 mg
nocte and fluoxetine 20mg/daily. She takes over-the-counter (OTC) paracetamol and
ibuprofen for occasional headaches, back pain and menstrual cramps. Flora states she smokes
two packets of cigarettes per week to help with stress.
Arriving on the ward Flora’s vital signs are:
Blood Pressure: 116/52 mmHg
Heart Rate: 116 beats/minute
Respiratory Rate: 24 breaths/minute
Oxygen Saturations: 98% on room air
Temperature: 36.7˚C
Glasgow Coma Scale (GCS) 14/15 (E = 3, V = 5, M = 6)
Describe the common signs and symptoms of depression.
4
The possible symbols and indications of depression are felling sad, loss of interest
from activity, changes in behaviour, anxiety, and agitation. The patient can also
suffer from other symptoms such as sleeping disorder, loss of appetite, lack of
concentration, decreased energy level and self-esteem, fatigue, rapid mood
swings.

5WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Describe the therapeutic use and pharmacological action (mode of action) of fluoxetine.
Flora also has type 2 diabetes. Describe the impact that trauma and stress can have on blood
glucose levels.
5
Fluoxetine is used to treat obsessive compulsive disorder, panic attacks, and depression,
eating disorder called bulimia, and also for acute premenstrual syndrome disorder. It is a
selective serotonin reuptake inhibitor (SSRI) thus inhibiting the presynaptic reuptake of
the neurotransmitter serotonin. It further interacts with 5-hydroxytryptamine receptor and
has capability to upsurge the levels of dopamine and noradrenaline in the prefrontal
cortex. Thus it acts as antidepressant.
In an injured patient, the stress reaction elicits amplified level of plasma glucocorticoids
such as cortisol and catecholamine. Surplus stress level indicates to elevated cortisol and
decreases the capacity of insulin in terms of producing or using by cells, which in turn
lead to increase the levels of glucose.

6WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Flora is prescribed 5 – 10 mg of intravenous (IV) morphine to manage her acute pain and 8
mg (orodispersible) ondansetron to manage any associated nausea. Explain the therapeutic
use and pharmacological action (mode of action) for each of these medications.
Describe the nursing responsibilities of administering IV morphine
6
Therapeutic use of morphine- this medication is used to relieve from less to acute pain. It
acts as agonists of mu and the kappa opioid receptors which produce analgesia later. The
ondansetron is used to cure in vomiting and nausea after surgery and also prevent nausea
caused by radiation therapy and chemotherapy and. It is a serotonin antagonist that blocks
the serotonin receptors that causes nausea.
At first the nurse should maintain sanitization process so that any kind of infection cannot
take place in the patient. The nurse should know about the anatomy and physiology of the
body to insert the needle in a vain. She should take care of minimizing the pain at the time
of administration of needle. The nurse should have knowledge about the appropriate
dosage of the morphine. For intravenous administration, the nurse must inject the
morphine slowly over a period of 4to 5 minutes.

7WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
The orthopaedic doctor also prescribes Flora regular ibuprofen and paracetamol pro re nata
(PRN) while on the ward. Explain the therapeutic use and pharmacological action (mode of
action) of ibuprofen and paracetamol.
Explain why ibuprofen was prescribed as a regular medication and paracetamol as PRN.
Flora is on the waiting list to go to theatre for stabilisation of her fractured pelvis. What is
important to consider when developing a pre-operative plan of care for Flora?
7
The medical use of ibuprofen is to relieve from pain such as muscle strains, headache,
menstrual cramp, dental pain, arthritis. It also helps in treating fever and reducing pain or
negligible ache because of flu or cold. It is also an anti-inflammatory drug. The
mechanism of Ibuprofen is non-selective, reversible inhibition of the cyclooxygenase
enzymes COX-1 and COX-2. It exhibits pain-relieving properties and anti-inflammatory
by hindering both the COX isoforms. The paracetamol is a pain reliever and it is the main
medicine to relieve in fever. It is also helps to minimize headache, pain, muscle strain,
arthritis, toothaches, backache, and colds. Its action is mediated through activation of
descending serotonin pathways. It may inhibit synthesis of prostaglandin or activate
metabolite influencing cannabinoid receptors.
Ibuprofen was prescribed as a regular medicine as Flora has predisposition of headache,
menstrual cramps, and backache. Nonetheless, paracetamol was prescribed as PRN as
Flora had been suffering from hip pain and recently she had undergone a surgery also the
paracetamol is used to heal other kind of health conditions.
It is to be examined in Flora whether airway, breathing and circulatory responses are proper
functioning or not. Additionally she has type 2-diabetes that is to be considered significantly.
Duplex ultrasonography should also be performed in prior to the operation. External fixation
should be taken to consideration for her unstable pelvic fracture.

8WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Flora is concerned regarding her seat-belt injuries as there are significant abrasions on her
chest and abdomen, which are painful. Describe the possible thoracic complications caused
by seat-belt injures and what are their signs and symptoms?
The possible complications in thoracic region triggered by seat-belt damages describe the
cervical and upper thoracic spine fractures. The signs and indications of cervical fracture
include pain, swelling or muscle in neck, tenderness. It also includes facing trouble to turn or
twist the neck freely, numbness or tickling at the base of head. If the fracture occurs in upper
thoracic spine region, the patient may face temperate to acute pain that is related with
movement. In relation to spine the patient can experience bowel or bladder dysfunction along
with weakness in the limbs, unresponsiveness, or tingling. If the fracture is initiated by brain
injury, high-energy trauma, and loss of cognizance or black out may be happen.
Flora asks the nurse how she will be able to have a cigarette when she needs one. How
should the nurse respond?
8
Nurse should handle the situation tactfully. She should tell the nurse about the adverse
effects of smoking and ask the patient not to perform such things in ward. Since other
patients having severe illness are present with her, it raises ethical concern regarding this
matter.

9WORKBOOK FRAMEWROK ON CASE STUDY OF A PATIENT
Describe what interventions and support services are available to Flora on the ward regarding
her nicotine dependence.
Nurses are required to provide ongoing education to clients in any clinical setting on a variety
of topics. Describe the generic components of an education plan.
Flora has asked about support to help her stop smoking. She states she has not had a cigarette
for three days and thinks now may be a good time to stop. Consider interventions and
supports that are available for the nurse to utilise in developing a smoking cessation plan for
Flora.
9
Since Flora has dependency on nicotine, a support system must be implied so that the
team will provide her mental support, help to take possible actions to withdraw the
addiction of nicotine. One service should be inferred where the people with same
condition should be kept in a particular place and possible measurement should be taken.
For starting an education plan, nurses should consider some generic components. The first
component is plan. Nurses must form a planning prior to the training to the clients. Then,
she should set a goal in which she would perform. Second factor is risk factors. She must
consider the risk factors about the work she is going to perform. The next factor is the
willingness to learn. In this factor, nurse should evaluate the patients willing to learn about
the clinical setting. Another factor that is the engagement of the clients that would
consider the patient’s active participation regarding this education.

Running head: CASE STUDY WORKBOOK
Nurse should treat the patient in non-judgemental way. She can describe her personal
experience so that the patient can understand the situation in better way. The nurse should
convey the possible disease and risk factors of smoking. She must identify the barrier and
should inform the patient so that patient can come out of the addiction.