Case Scenario #3

A 26 years old male was brought into the ER by EMTs and paramedics via ambulance after being involved in
a MVA 2hours ago. EMTs stated that patient was noted to be intoxicated at the scene of the accident and
with DUI . The patient was noted to be lethargic, knows own name only, does not know where he is and does
not know the current date and not able to able to follow simple commands. VS 100/60, PR 90/min, RR
22/min, temperature 37 degrees Centigrade axillary, complained of throbbing generalized pain with
numerical scale 7/10. Further assessment yielded rib fractures of right ribs 3
rd
to 5
th
and open fracture at
right tibia and comminuted fractures at right hip ; burned areas all described as white dry leathery areas at
right side of the face, right shoulder, front abdomen and right lateral thigh. Pulse oximetry reads at 91%.
The patient also has multiple lacerations on his arms and legs namely: left forearm measuring 7cm X 4cm
X less than 0.1cm; left upper arm measuring 3cm X 3cm X 5cm; left shin measuring 5cm X 2cm
X 1cm ; right medial thigh measuring 8cm X 1cm X 0.5cm. All the lacerated areas described as with red
wound bed 100% with sanguinous drainage, non-foul. Additionally, the patient also sustained a SCI T6 to
T8 Fracture ASI A C . The patient is 56 with ABW of 165 lbs. The patient is directly admitted to the I CU.
Previous patient history yielded that patient is a known cocaine user and known ETOH abuse since 2008;
A. Considering the patients condition, what are the priority assessments on the patient?
a. Give the rationale for doing such assessments.
b. What is the calculated GCS? Rationale?
c. How would you check for effect of the SCI?
B. Based on your assessment findings, what are the priority nursing problems and priority treatment needs
of the patient on the scene of the accident taking into consideration the triage principle?
a. Give the scientific rationale for the problems and treatment needs.
b. What do you expect the EMTs and paramedics to have done on the patient while at the scene of
the accident?
c. What possible contraptions do you expect the patient to have upon arrival at the ER? Give the
rationale for such contraptions.
C. What possible diagnostic exams will be done upon arrival in the ICU? Give the rationale and nursing
responsibilities for such exams?
D. What possible early serious complication/problem should you anticipate considering the location of the
patients burns?
a. What would be your priority action for this problem?

The patient is started on fluid resuscitation therapy.
E. Using the rule of nines, estimate the percentage of TSBA burned.
a. Estimate his fluid resuscitation needs for the first 48 hrs?
b. What IVF do you expect the doctor to order?
F. How do you classify the patients burns basing on the description in the abovementioned?
G. What are his possible treatments for his burns in the 1
st
48 hrs?
H. What are the possible complications secondary to burns that patient is at risk for each stage of burns?
I. Basing on his lacerations, which wound will need priority treatment? Rationale? What are the possible
treatment options for his lacerations?
J. What is the implication of the patient having the diagnosis of SCI T6 to T8 ASIA C?
a. What are the s/s that the indicate patient is suffering from spinal shock?
b. What is the prognosis of the patient having ASIA C SCI diagnosis? Why? (support your
answer)

The patient was placed on the traction pending surgery at the right hip and right tibia. The patient
was noted to be with flail chest.

K. What kind of traction would the patient likely have?
a. What is the purpose of this intervention?
b. What are the nursing responsibilities regarding the care of our patient with this kind of traction?
L. What is a flail chest? Give the possible treatment options for a patient with flail chest? Rationale?

The patient underwent Right Hip THR and placement of external fixator at the right tibia and
placement of Greenfield filter.
M. What is the rationale for the placement of the Greenfield filter?
N. What are the nursing responsibilities S/P THR and placement of external fixator

The patient suddenly complained of severe throbbing headache 10/10, VS 120/90, PR 60/min,
R23/min, axillary temperature 36.8 degrees Centigrade. The patient is also noted to be flushed and
very anxious.

O. Taking into consideration the patients DX and assessments, what is the possible problem that the
patient is suffering from?
a. What are your priority treatments for patient suffering from this problem?
b. Give the rationale for these treatments?
c. Why is the patient prone to this disorder?

After the patient was stabilized, the patient suddenly complained of dyspnea. VS 102/60, PR 98/min,
RR 30/min, axillary temperature of 37 degrees Centigrade. The patient complained of feeling very
anxious and feeling of doom. Pulse Oximetry reads at 88%. Diminished breath sounds were noted at
Right lung field.

P. Based on your nursing assessment, what is patient suffering from?
a. What are the diagnostic and treatment options for this? Give their rationale.
The patient VS 80/40, PR 110/min described as weak and thready, RR 20/min, axillary temperature of
36.5 degrees Centigrade. UO noted as 25ml per min.
Q. Basing on your assessment, what is the patient experiencing?
a. What are the possible treatment options? Rationale?
b. What would be your relevant nursing diagnosis and nursing interventions for the patient?

Patient suffered cardiopulmonary arrest. Code Blue was paged.

R. What are the priority treatments for patient with cardiopulmonary arrest?
a. What are the different responsibilities of the different members of the Code Blue team?
b. What is the difference between the Rapid Response Team and Code Blue team?

Patient expired after 20 minutes of CPR and ACLS. The patients family requested an autopsy.
S. What is the purpose of an autopsy?

T. What your nursing responsibilities related to the post mortem care of our patient?

U. What are the nurses responsibilities when it comes to handling a medico-legal case?


Note: For all discussions, kindly indicate the reference used and their respective pages. Use only textbook
references.