NRSG366 Clinical Handover Report: ISBAR Analysis and Recommendations

This report presents an ISBAR (Identity, Situation, Background, Assessment, Recommendation) handover example for a patient with renal failure and diabetes mellitus. The student, a registered nurse, details the patient's history, current medications (including metformin, calcitriol, and erythropoietin), and the impact of diabetes on renal function, including diabetic neuropathy and arterial hyalinosis. The assessment section highlights skin breakdown, vital signs (including elevated blood pressure), and pain levels. Recommendations include ordering a new catheter, further renal assessment by a urologist, and blood tests. The report also outlines two goals: improving renal function within two weeks and developing functional independence within three months, with corresponding interventions such as daily catheter care, perceptual tracking exercises, and sleep enhancement. References to relevant literature support the clinical reasoning and interventions discussed in the handover.

Running head: USE OF ISBAR IN NURSING
USE OF ISBAR IN NURSING
Name of Student
Name of University
Author note

1USE OF ISBAR IN NURSING
ISBAR HANDOVER
I - Identity – I am John, registered nurse at urology department caring for Mr. Anh Duong, a
catheter assisted patient with renal failure.
S - Situation – This is Mr. Anh Duong, 74 years of age admitted with reddened area around
catheter. I am caring for Mr Duong since my morning shift for 8 and half hours. The catheter
infection is being treated with medications.
B –Background –
Patient History and current medications
 Mr Duong has a medical history of a long term expression of non-insulin
dependent diabetes mellitus which has resulted in his renal failure and catheter
assistance.
 For diabetes mellitus, he has been taking metformin 1gm BD and for renal
failure, he has been taking calcitriol 0.025mcg BD and erythropoietin 60 units
per week.
 Diabetes mellitus leads to kidney diseases by thickening of intimal hyaline
which later progresses to a state of arterial hyalinosis in the efferent and
afferent arterioles leading to glomerular hyper-filtration (Moriya et al., 2017).
Diabetes, in Mr. Duong is the chief etiology of diabetic neuropathy which over
a long period of progress has led to renal failure.
 Mr. Duong has also been receiving peritoneal dialysis at home due to his
condition of severe renal dysfunction (Yu & Yang, 2015). To maintain the
phosphate buffer, Mr. Duong has been taking calcium carbonate in dialysis.

2USE OF ISBAR IN NURSING
 Long term diabetes persistence has led to impaired vision which makes him
dependent. Mr Duong also has hypertension and has been taking ramipril
10mg mane, captopril 12.5 mg TDS.
 High blood pressure can lead to fast spread of infections and quick
hemodynamic shifts – leading to skin hypersensitivity and if not managed, it
can lead to a systemic anaphylaxis as well”.
A -Assessment –
 Skin assessment - Swelling and skin breakdown were the chief findings around the
urethral opening which has resulted in reddening around the catheter area (Newman &
Wein, 2018).
 General assessment -His vital signs except for blood pressure which is 150/90. There
is no signs of angina or breathing distress. Oxygen saturation is stable at 95. Mr.
Duong was assessed with fever and chills this morning.
 Catheter/ urinary assessment - patient has urinated twice, the flow was quite normal
with no signs of blood or debris.
 Pain assessment - Patient has complained of pain around the catheter area, on a sale of
5 on 10.”
 Psychological assessment – cognition is fine, emotional state – depressed, behavioral
state – anxious
 Home/ living environment assessment – lives in his own home with wife. Active in
locality.
R -“Recommendation” – “I think a new catheter should be ordered for Duong. His urinal
pain should also be assessed for and checked for underlying pathology. A thorough renal

3USE OF ISBAR IN NURSING
assessment can be done again by the attending urologist. Mr. Duong’s fever is still persistent
and immediate blood test must be advised for.”
Goal 1: To better renal function (two weeks)
Interventions
 Daily catheter care, with promotion of drug adherence in Mr. Duong to better his
renal condition is my short term goal which I frame to achieve in 15 days.
Goal 2: Developing Functional independence (three months or twelve weeks)
Interventions
 Improvement of Activities of daily life activities in Mr. Duong is the next goal which
I plan to achieve in three months. Impaired vision which has hindered Mr. Duong’s
functional independence needs to treated which I intend to deliver with the assistance
of physical therapist.
 Perceptual tracking exercises and hand function training.
 Frenkel’s exercises can be used in Mr. Duong’s case.
 Sleep and relaxation must be enhanced as well.

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References
Kitney, P., Tam, R., Bennett, P., Buttigieg, D., Bramley, D., & Wang, W. (2016). Handover
between anaesthetists and post-anaesthetic care unit nursing staff using ISBAR
principles: A quality improvement study. ACORN: The Journal of Perioperative
Nursing in Australia, 29(1), 30.
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y. S., Noble, D., Norton, C. A., ... &
Hickey, N. (2010). The ‘five rights’ of clinical reasoning: An educational model to
enhance nursing students’ ability to identify and manage clinically ‘at
risk’patients. Nurse education today, 30(6), 515-520
Moriya, T., Omura, K., Matsubara, M., Yoshida, Y., Hayama, K., & Ouchi, M. (2017).
Arteriolar hyalinosis predicts increase in albuminuria and GFR decline in normo-and
microalbuminuric Japanese patients with type 2 diabetes. Diabetes care, 40(10),
1373-1378.
Newman, D. K., & Wein, A. J. (2018). External Catheter Collection Systems. In Clinical
Application of Urologic Catheters, Devices and Products (pp. 79-103). Springer,
Cham.
Pang, W. I. (2017). Promoting integrity of shift report by applying ISBAR principles among
nursing students in clinical placement. In SHS Web of Conferences (Vol. 37, p.
01019). EDP Sciences
Yu, X., & Yang, X. (2015). Peritoneal dialysis in China: meeting the challenge of chronic
kidney failure. American Journal of Kidney Diseases, 65(1), 147-151.