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Mr Chan is a 76-year-old retired teacher. He has fallen from a ladder while cleaning the gutters on his two-story house. His neighbour called an ambulance and he has been transferred to the emergency department of a major city hospital. He was found on his left side. At the scene he complains of pain on the left side of his chest, abdomen, and his left for arm. He was conscious at the scene and his GCS was 15. He was breathing spontaneously at a rate of 28bpm, Spo2 96%, Heart rate 110bpm, BP 140/80mmHg and temp 35.6 degrees Celsius.
Paramedics administer oxygen via a non-rebreather mask at 15L/min. They immobilise him on a back board and apply a cervical collar. They insert a 18 gauge IV cannula in his right forearm and have commenced 0.9% Sodium Chloride. They administer morphine for pain and transport him to the emergency department of a major city hospital.
On arrival in the emergency department he is awake and able to recall his fall. He complains of pain on the left side of his chest and abdomen on palpation and in his left forearm. His GCS remains 15. He is breathing spontaneously at a rate of 30 bpm, Spo2 94% on the non-rebreather, Heart rate 120bpm, BP 98/60mmHg and temp 35.6 degrees Celsius.
On examination Mr Chan has suffered the following injuries.
Fractured ribs 8-10 and left Haemothorax, Fractured left radius and ulna, ruptured spleen.
Please choose one of the following questions.
Outline nursing assessments and interventions in order of priority that would occur in the emergency department. When providing your response, you should consider any potential complications the nurse might expect Mr Chan to encounter? You should outline the nursing interventions in order of priority using a systematic approach that would be appropriate to prevent Mr Chan’s condition from getting worse and to prevent further development of any complications you identify.
2. After he is stabilised in the emergency department Mr Chan is sent to surgery for repair of his fractured forearm. This involved insertion of a plate and screws. A left sided chest drain was inserted and a subclavian central line. A laparotomy was performed to remove his ruptured spleen. Post operatively Mr Chan is transferred to the surgical high dependency ward. You are the nurse caring for Mr Chan in the surgical high dependency ward. He is monitored in sinus rhythm 123 bpm, with an arterial line BP 100/70mmHg, he is currently receiving 2L of nasal prongs with a saturation of 93%, Temp 37.2 degrees celsius. Discuss the nursing assessments and interventions you would perform for Mr Chan in the high dependency unit.

When providing your response, you should consider any potential complications the nurse might expect Mr Chan to encounter? You should outline the nursing interventions in order of priority that would be appropriate to prevent Mr Chan’s condition from getting worse and to prevent further development of any complications you identify. This assessment should be submitted in a modified essay format. This means students are required to include an introduction, body, and conclusion in their work. Headings are acceptable but dot points, lists, pictures, and tables are not.
You are required to write an essay of 2,500 words.
This assessment requires you to explore the evidence base for nursing care in a high acuity environment. You will need to analyse the current literature including research papers and journal articles to answer the question. The essay must show evidence of critical analysis, synthesis, and evaluation of relevant research literature. That is, textbooks and other secondary sources do NOT qualify as suitable reference material for uncovering the evidence base for best practice. PubMed, The Cumulative Index of Nursing and Allied Health literature (CINAHL) and Medline are useful sources to locate the research evidence for this essay. Protocols may be used as references if relevant to the case study and contemporary Australian nursing practice.

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