Respiratory Rate Discussion Paper

A-E ASSESSMENT AND SBAR

Scenario 1: A-E assessment

Airway:

  • Patent

Breathing:

  • SPO2 @ 91% – provide oxygen via face mask
  • with shortness of breath (SOB) with a respiratory rate of 29 bpm – position position in a semi or high fowlers position to promote gas exchange
  • right lung is clear, left with some crackles, coughing – if with sputum examine the color, consistency, quantity, and odor Respiratory Rate Discussion Paper

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Circulation:

  • pulse 98 – normal
  • BP 100/52 – establish IV access and anticipate the need for IV fluid infusion
  • appears pale and has vomited twice

Disability:

  • post open cholecystectomy 3 days – anticipate pain on site, careful with positioning the patient and assess pain
  • alert but complaining of feeling unwell

Exposure:

  • Temperature 38.8 C – take blood samples and blood culture as per orders, administer antipyretic such as Paracetamol IV and antibiotics as per Doctor’s order
  • Wound site small amount of dry blood Respiratory Rate Discussion Paper

Scenario 2: A-E assessment

Airway:

  • Patent

Breathing:

  • SPO2 @ 92% in room air – provide oxygen via face mask
  • respiratory rate of 29 bpm – due to pain

Circulation:

  • pulse 130 – due to pain and fever
  • BP 90/65 – establish IV access and anticipate the need for IV fluid infusion

Disability:

  • car accident 4 days ago with fractured femur post open reduction, external fixation
  • with internal pins and external immobilization
  • pain around his pin sites

Exposure:

  • Temperature 38 C – administer antipyretic such as Paracetamol IV and antibiotics as per Doctor’s order
  • Wound site: red with some swelling and purulent exudate

Scenario 1: SBAR

Situation:

  • I am _______ from ward _________, and I am calling regarding patient Linda.
  • I am concerned that she has developed shortness of breath, pyrexia, and a decrease in her oxygen saturation.
  • Her BP is 100/52 mmHg with a pulse rate of 98
  • O2 saturation is at 91% and she’s coughing with a respiratory rate of 29 bpm
  • On auscultation her right lung is clear, with some crackles noted on the left lung.
  • Her temperature is at 38.8 C.

Background:

  • Linda is 67 years old and was admitted for an open cholecystectomy and is 3 days post op. Her wound has dry wound but nothing abnormal noted on the wound.
  • I have hooked her to the monitor and started her on oxygen via face mask. and positioned her to a comfortable position. I have established an IV. Respiratory Rate Discussion Paper

Assessment:

  • I think she may have developed Pneumonia as a complication of her surgery.

Recommendation:

  • I need you to come and check on her as soon as possible. She may need fluids, medication and antibiotics.
  • In the meantime is there anything that you want me to do?
  • Do you want me to send the patient for CXR, take blood samples and blood culture samples, and also sputum samples?

Scenario 2: SBAR

Situation:

  • I am _______ from ward _________, and I am calling regarding patient Josh.
  • I am concerned that he is feeling unwell with pyrexia. He also appears pale and has vomited twice.
  • His BP is 90/65 mmHg with a pulse rate of 130 bpm
  • O2 saturation is 92% at room air with a respiratory rate of 29 bpm
  • His temperature is at 38 C and complains of pain around his pin sites.
  • His wound is red with some swelling and purulent exudates Respiratory Rate Discussion Paper

Background:

  • Josh is 25 years old and had a car accident 4 days ago. He had a fractured femur that required him to have open reduction and external fixation. He has internal pins and external immobilization.
  • I have given him oxygen via face mask and established an IV.

Assessment:

Recommendation:

  • I need you to come and check on him. He may need fluid, medications and antibiotics.
  • In the meantime is there anything that you want me to do? Respiratory Rate Discussion Paper
  • Do you want me to take samples from the wound site?

Look at the two scenarios and complete an A-E assessment and SBAR Use critical thinking to identify any further gaps in your knowledge and use the remaining time to search for more information. Scenario 1: Linda is 67 years. She was admitted for an open cholecystectomy and is now 3 days post op. On the ward she is presenting with a shortness of breath, pyrexia and decreased oxygen saturations. Pulse: 98 Blood Pressure: 100/52 Resp Rate: 29 Oxygen saturations: 91% in air and coughing Temperature: 38.8 Chest auscultation (by appropriately trained staff) : Right lung is clear, left has some crackles Wound site: small amount of dry blood but nothing of note. Scenario 2: Josh is 25 years old and was in a car accident 4 days ago. He had a fractured femur that required open reduction and external fixation, internal pins and external immobilisation. Today he is complaining of feeling unwell with a pyrexia. He appears pale and has vomited twice. Pulse: 130 BP: 90/ 65 Resp rate: 29 Oxygen saturations: 92 in air Temperature: 38 Pain: Complaining of pain around his pin sites Wound site: red with some swelling and purulent exudate Respiratory Rate Discussion Paper