discuss one independent nursing intervention and one dependent nursing intervention for the actual problem.

CASE EXAMINATION:

Natalie Hill (pronouns she/her) is a 42-year-old female admitted to University Hospital by

ambulance at 0420am following a motor vehicle accident (MVA) at 80km/hr. The car had

impact with the metal lane barrier. Natalie was the driver, with no other persons in the car at

the time of the crash.

Natalie’s primary survey upon immediate arrival to the Emergency Department (ED) of

University Hospital (UH) demonstrated the following:

A: Airway cleared, Yankeur suctioning required to remove vomitus. Blood noted in

mouth, 3 front teeth loose. Speaking inappropriate words, drowsy. C-spine collar in situ

B: Respiratory rate (RR) 26 per minute, laboured. Decreased breath sounds to right

lower lobe, and left lung. Equal chest symmetry. SpO2 84% at scene, 99% 10 L oxygen

via Hudson mask (HM).

C: Heart rate (HR) 121 beats per minute, pulse thready and regular. Blood pressure

90/58 mmHg. Skin is cool, pale, clammy. Capillary refill (CR) > 3 seconds. 2L 0.9% Normal

Saline IVT administered by paramedics. 2 x IV cannula inserted left and right antecubital

fossa. Positive focused assessment with sonography in trauma (FAST) scan. Hb 94g/L.

D: Glasgow coma score (GCS) 10 (E2V3M5). PEARL size 3+. Blood glucose level

11.1mmol/L mmol/L.

E: Temperature 35.5 degrees Celsius, Bair Hugger warming blanket applied. Multiple

lacerations and contusions evident on all limbs, abdomen and face. Significant bruising

and swelling to right lower leg, toes mottled and cool.

 

 

 

 

 

 

 

 

 

 

QUESTIONS:

Question 1. (approx. 250 words)

The above data outlines what is involved in the primary assessment of Natalie. From this

information, rationalise one actual/priority problems and two potential problems. Underpin

your responses with underlying pathophysiological causes to justify your decision

making. Link to other signs and symptoms as applicable.

 

Answer:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You have now performed a secondary survey of Natalie. Some diagnostic results and physical

assessment data gathered from this includes:

Vitals: BP 99/60mmHg; RR 28; SpO2 94% 10LHM; HR 134bpm, Temperature 36.1

GCS 12 (E3V4M5); C-spine collar remains in situ. Periorbital bruising noted. PEARL 3+sluggish.

Await head/neck/spine CT scan. Lung sounds remain unchanged from primary survey, nil signs

of subcutaneous emphysema, nil tracheal deviation. Weak and thready radial pulses, heart

sounds S1 S2. Hb 79g/L.

Log-roll performed: palpation of spine NAD (No Abnormalities Detected) and posterior

inspection NAD. Tenderness and localising to abdominal palpation, bowel sounds decreased.

Not passed urine. Right leg: immobilised in splint, CR 4 seconds, cool peripherally, dark bruising

++ to leg and foot with right dorsalis pedis and posterior tibialis pulses weak.

 

Question 2: (approx. 250 words)

From the secondary survey data, rationalise one actual problem (different from Q1). Then

discuss one independent nursing intervention and one dependent nursing intervention for the

actual problem. Underpin your responses with possible underlying pathophysiological causes to

justify your decision making. Link to other signs and symptoms as applicable.