Case Analysis: Management of Jane Wilson’s Injury and Care

QUESTION

Jane Wilson is a 30-year-old female who presents to the regional Emergency Department (ED) by herself. She is hobbling up to triage whilst holding her left leg. Jane reports she had fallen off her horse and has suffered a deep and dirty penetrating laceration to her left thigh. Jane appears alert and orientated. Jane can recall all history of events and answer questions appropriately. Jane has wrapped her thigh with a towel to stop the bleeding. In the ED the towel is removed, and the wound is irrigated with normal saline before being redressed with a pressure bandage. It is not possible to insert a peripheral intravenous (IV) canula, so a decision to obtain access through a Central Venous Access Device (CVAD). The CVAD has been performed on Janes L) Jugular vein under sterile technique. The CVAD is patent and secured with sutures and a transparent IV 3000 dressing. Triage Observation Airway: Patent, own, RR: 16 Sp02: 92% on Room Air (RA) BP: 105/52 HR: 118, regular T: 35.5 Pain 6/10 GCS 15 BGL: 5.5 Medical History Nil allergies Denies any alcohol intake or illicit drug use Independent and active Investigations Hb: 89g/L (Cross match report: AB+) X-ray: No bony fractures or abnormalities visible. CT: Deep laceration to left medial thigh. No associated vascular injury present. In the ED, one unit of Packed Red Blood Cells (PRBCs) is administered through the CVAD. After the first unit of blood, Jane is admitted to the surgical ward to wait for surgery as the ED is now becoming overcrowded. 1g Paracetamol and a Stat dose of Ceftriaxone has been administered by ED staff. School of Nursing, Paramedicine and Health Science NRS283_202360 Assessment item 1: Case Analysis. 3 You are working as a Registered Nurse on the Surgical Ward and when you assume care of Jane and when you introduce yourself to Jane it is 1430. Jane appears anxious and remains in pain. Jane can recite her full name, date of birth and can tell you the time and place. It is obvious Jane is worried and tries to call her wife, Emily, but is unable to get in contact. Initial admission observations to the ward Airway: Patent, own, RR: 16 Sp02: 93% on RA BP: 107/60 HR: 105, regular T: 34.9 Pain 6/10 GCS 14 (Eyes open to voice, orientated and obeying commands) BGL: 5.4

ANSWER

Case Analysis: Management of Jane Wilson’s Injury and Care

Jane Wilson, a 30-year-old female, presents to the regional Emergency Department (ED) with a deep and dirty penetrating laceration to her left thigh following a fall from a horse. She arrives at triage holding her injured leg and appears alert and oriented. In the ED, the wound is irrigated and dressed, and a Central Venous Access Device (CVAD) is inserted due to difficulty in obtaining peripheral IV access. After receiving one unit of Packed Red Blood Cells (PRBCs), Jane is admitted to the surgical ward with ongoing pain and anxiety. This case analysis will focus on the management of Jane’s injury and care, addressing the assessment, nursing interventions, and considerations for her well-being.

Assessment and Nursing Interventions

Upon assuming care of Jane on the Surgical Ward, the nurse should conduct a comprehensive assessment to address her physical and psychological needs. This includes monitoring vital signs, assessing pain level, ensuring adequate oxygenation, and evaluating her overall mental state. The nurse should address Jane’s pain by administering pain relief as appropriate, considering her individual pain threshold and response to interventions. Collaborating with the medical team, the nurse should ensure that the prescribed Paracetamol and Ceftriaxone doses are administered according to protocol.

Jane’s distress and anxiety should be acknowledged and managed. The nurse should engage in therapeutic communication to alleviate her worries and provide emotional support. Facilitating communication with her wife, Emily, if possible, can help ease her anxiety. If phone contact is not feasible, offering to relay messages or facilitating a call when possible would demonstrate patient-centered care.

Patient-Centered Approach

Jane’s well-being should be the central focus of care. Implementing a patient-centered approach involves involving her in the care plan, considering her preferences and values. Collaborative decision-making ensures her autonomy and enhances the nurse-patient relationship. Considering her pain level and emotional state, the nurse should advocate for timely interventions to address her discomfort and anxiety.

Collaborative Care

Jane’s multidisciplinary care team should collaborate to ensure her holistic needs are addressed. Communication among the medical team, surgical team, and nursing staff is essential to provide coordinated care. Since Jane has a CVAD, the nurse should ensure its proper function, securement, and monitor for any complications.

Conclusion

Jane’s case highlights the importance of a patient-centered and collaborative approach in providing comprehensive care to individuals with complex injuries. The nurse’s role involves conducting thorough assessments, managing pain, addressing emotional needs, and advocating for effective communication among the healthcare team. By tailoring care to Jane’s individual needs and fostering a supportive environment, healthcare professionals can enhance her recovery and overall well-being.