Introduction

Introduction:

Hello Dr. Shah, this is nurse Yogisha Patel calling from Med Surg Dept.

S - Situation:

Jenise Buckler, in room 115, is a 71-year-old American female who is having chest pain and shortness of breath. She is mark ably unwell.

B - Background:

Mrs. Buckler has a long history of chronic obstructive airways disease and anxiety, increasing hospital admissions over the last 3 years. Her last hospital admission was 12/15/2019. She is a reformed smoker. Her medication regime includes home oxygen, an inhaled corticosteroid, theophylline, and a long-acting bronchodilator. Also, patients have high cholesterol and high BP.

Medications: Sertraline 25 mg PO qDay, Lipitor 20 mg PO qDay, Lisinopril 10 mg PO 1Day. She prescribed NITROSTAT 0.3 mg in 2019 as well. She has NO known allergies to current medications. Labs were drawn on 4/25/21 @1315 for CBC, CMP, Lipid Panel, and urinalysis & chest X-rays (results pending).

A - Assessment:

Mrs. Buckler is extremely anxious and distressed. Her presentation for this event is more severe than on previous occasions. An ECG was negative for acute changes. On physical assessment, her temperature is 96.7 F, blood pressure 190/100 mmHg, heart rate 118 bpm, respiratory rate 34 per minute, SpO2 87% on RA. She is unable to perform a peak flow reading. I suspect she is suffering from an infective exacerbation of chronic obstructive airways disease. Blood and sputum specimens have been taken before the commencement of an intravenous fluid regime and antibiotics.

R - Recommendation:

I recommend that Mrs. Buckler be retrieved from an institution for definitive management of exacerbation of chronic obstructive airways disease as soon as possible.

R - Read Back:

To be clear, you would like to start the patient NITROSTAT 0.3 mg at this time before transferring her for advanced care.

2 I- Good morning Dr. V. This is Lisa, RN calling from step down unit with ABC General Hospital.

S- Mr. Tomahawk has just been transferred from medical surgical unit following chest tube placement for fluid on the lungs

B- Mr. Tomahawk was admitted to the ER 3 days ago with complaints of pain in the side when coughing, shortness of breath and productive cough that had been ongoing for 5 days before his brother called the ambulance to have him brought to the ER by ambulance after dizziness and LOC. He did not sustain any head injuries because he felt faint while sitting on the couch. Mr. Tomahawk has a history of recurrent pneumonia and chronic asthma with exacerbation

A- Upon entering Mr. Tomahawk's room, I noticed the drainage system was lying on the floor and there appears to be an air leak. An assessment was completed. VS are as follows: BP 148/92, HR 83, RR 20, O2 94%, pt reports no pain but has slightly increased shortness of breath after forgetting to splint near the recent insertion site when coughing

R- The site where the chest tube disconnected has been covered with an occlusive dressing. I recommend replacing the chest tube and applying a new occlusive dressing

R- For clarification, replace chest tube and in a sterile fashion, open the feet of drainage system and place below the bed and make sure it is upright and secure

please comment /discuss on my above two post if you agree or disagree. Please explain and include references"

SBAR is a communication tool and your Situations, Backgrounds, Assessments, and Recommendations are well outlined and conform to the SBAR structure. Here are some comments and suggestions for each scenario:Here are some remarks and recommendations for each of the three described scenarios:

 Scenario 1: Discussing with Dr. Shah:

 Strengths:

 Situation: Describes the state of the patient at the time and the problems of the patient.

 Background: The following major areas are discussed: to the patient’s past and present medical history, the medication history.

 Assessment: The results of the assessment and your feeling that the patient may have an acute on chronic exacerbation of chronic obstructive airway disease (COPD).

 Recommendation: Extremely supportive of the patient to be transferred for further management.

 Read Back: It helps the action that requires to be done to be highlighted and also make one to have a clear understanding.

 Suggestions:

 Assessment Detail: However, there are some aspects where the assessment can be developed, for instance, the authors could have provided more information about the measures that have been done in the near future (e. g. changes made in oxygen therapy, choice of the first antibiotics).

 Recommendation Specificity: If possible, try to determine which type of specialized care facility or department would be appropriate for Mrs. Buckler; for instance, a pulmonology or an intensive care unit.

 Read Back: The read-back include the information about the management of NITROSTAT but it is important to establish whether this is in any way consistent with the current guidelines for her condition.

 References:

 American Nurses Association (ANA). (2015). The ethical standards by which nurses are expected to conduct themselves in the course of their practice are found in the Code of Ethics for Nurses with Interpretive Statements. ANA.

 Some of the organizations include the Institute for Healthcare Improvement (IHI). (2017). SBAR: A Framework for Interaction. Retrieved from IHI. org

 The second case is; interaction with Dr. V.

 Strengths:

 Situation: Show the present condition of Mr. Tomahawk and shows the most recent procedures that Mr. Tomahawk has had.

 Background: The history of the patient in detail and the current issue with the chest tube are described.

 Assessment: VS are listed in the documents and there are assessment parameters.

 Recommendation: Outlines recommendations that can be made as a way of addressing the problem of disconnection with a view of improving the quality of service delivery to the patients.

 Read Back: Describes the steps that should be taken so as to prevent mistakes hence improving the correctness.

 Suggestions:

 Assessment Detail: It would also be helpful to have brief history and physical examination finding about the patient’s current respiratory status and any change in the breath sound or other findings except dyspneas.

 Recommendation Specificity: Ensure that the order for removal of chest tube should include the type of chest tube or drainage system which is to be used in case of another one.

 Follow-up: It might be useful to mention the fact that one should look for any problems or possible need for further assessments after the chest tube is removed.

 References:

 The American Association of Critical-Care Nurses (AACN) has defined the nursing care for the ICU/CCU as (AACN, 2016). Critical Care Nursing: The Fourth Approach: The Integrative View. Lippincott Williams & Wilkins.

 Nurses’ association of New Brunswick is the professional organization of nurses in New Brunswick. (2015). SBAR Communication. Retrieved from NABN. org