Over 200 cases reviewed. Here are some examples:
Obstetrical Standards of Nursing Care.
Pregnant with her third baby, a woman was admitted to hospital for a trial of labor after a previous Caesarean Section (VBAC). During Syntocinon induction of labor the fetal heart rate suddenly dropped and an Emergency Caesarean Section was performed. The scarred uterus had ruptured; the baby, the umbilical cord and part of the placenta were found in the abdominal cavity. The baby was severely compromised at birth and developed cerebral palsy, neurological impairment and seizures. This case involved a review of nursing responsibility for the use of Syntocinon for VBAC as well as the nursing standards of care for monitoring, recognizing and responding to signs of uterine rupture.
Nursing Scope of Practise.
A 29 year old rugby player with a history of Asthma arrived at a rural Emergency Department with complaints of chest pain and shortness of breath. His symptoms started during a rugby game after a particularly rough tackle. The E.R. physician, who was not in the hospital at the time, was consulted by telephone for medical orders. The nurse treated the patient with Ventolin and sent him home, but he died later that evening due to complications of a blood clot in his lungs. Review of this case involved examination of the nursing scope of practice, physician responsibility and at the risk factors and odds of surviving a Pulmonary Embolus in a small town.
Medication Errors.
A 7 year old girl was admitted to a large pediatric hospital late one evening with acute appendicitis. The young patient was known to have a severe allergic reaction to Penicillin. Following surgery to remove the inflamed appendix, a medical resident wrote post operative orders that included an order for a Penicillin-related antibiotic. A new nurse on the night shift administered the intravenous antibiotic and then left the patient’s room. Unattended, the young girl died within moments from anaphylactic shock. A review of nursing responsibility in medication administration and of the adequacies of current hospital policies to protect children, a particularly vulnerable population group, from fatal medication errors.
Fall Prevention in Acute Care Hospitals.
A 68 year old woman was admitted to hospital for a knee replacement and given blood thinners to prevent possible postoperative complications. On the evening following surgery, a dinner tray was left on her bedside table. After eating part of the meal, she became nauseated and rang the call bell for nursing assistance to get out of bed. When no help arrived after several minutes, the patient attempted to get up by herself. She fell at the bedside, fracturing both of her wrists and one of her elbows. Severe internal bleeding followed, requiring a blood transfusion and a greatly prolonged hospital stay. This case review required a look at hospital fall prevention strategies and nursing responsibility to identify, assess and provide intervention for at risk patients