Co-Work Case Study

I chose to create a scenario that was similar to an incident that occured to a co-worker when I was working on a med-surg floor as a new grad.

A 25 year old, male patient with cerebral palsy and poor motor control is admitted through the ER. He is complaining of severe abdominal pain, vomiting, and increased fatigue. Due to frequent hospitalizations in the past, he is well known to the team on the floor he is being admitted to. The RN admitting the patient, tells the ER nurse calling in report that she is very familiar with him and really doesn't need a a whole lot of details in her report. After admission to the floor, the patient continues to complain of pain and vomits a small amount of coffee ground emesis. After a physical assessment,

the nurse notes that he is pale, lethargic, complaining of abdominal tenderness and has diminished bowel sounds.
After seeing the patient, the physician writes orders for labs, an NG tube and a KUB. He places the chart on the desk where the unit secretary proceeds to order the labs and KUB. She then places the chart back in the rack. The transport team comes and takes the patient for his KUB. While being transported to x-ray, the patient vomits again and aspirates. After the KUB, he is returned to his room on the floor. No report is given. No one is notified of his return - not his assigned care provider, team member or unit secretary. Upon making her rounds, approximately an hour after his return, the RN finds the patient holding his hand to his chest with rapid respirations which rapidly turn to gasps, a low O2 sat on the monitor, and he appears significantly cyanotic. The RN auscultates and hears wheezing and crackles. She places a O2 mask on his face and calls for assistance. Within minutes, the patient is apneic and bradycardic proceeding into asystole. Resuscitation is unsuccessful.