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:
- I think he may have developed infection on his wound site.
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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