I-SBAR Shift Report Handoff | Nurse-to-Nurse Demo

Summary

In this detailed report, Katherine provides a handoff of a patient, Miss Claire, to Mike. Miss Claire, admitted for fatigue, dizziness, and palpitations, has suddenly worsened with rapid breathing and low oxygen saturation, suggesting a potential pulmonary embolism. Katherine details Claire's symptoms, medical history, and the current treatments being administered, including oxygen and heparin. A CT scan is planned to rule out a PE, and additional tests are underway. The transfer of care is thorough, with all necessary steps for stabilizing and monitoring Miss Claire carefully outlined.

Takeaways

• 😀 The script introduces the ISBAR communication tool, which stands for Identification, Situation, Background, Assessment, and Recommendation.
• 😀 The nurse reports that Miss Claire came in with shortness of breath and deteriorated rapidly, with oxygen saturation dropping to 86%.
• 😀 Oxygen support was increased from two liters to a venturi mask at 40% to stabilize her oxygen saturation levels.
• 😀 Lab results show an elevated d-dimer, but full lab results are pending. The patient has a history of clots and asthma.
• 😀 Miss Claire has a history of using birth control for 15 years, which is a significant risk factor for a pulmonary embolism.
• 😀 Vital signs include oxygen saturation ranging from 89% to 92%, increased respirations (28-32 per minute), and a pulse rate of 136.
• 😀 Blood pressure is low at 94/58, and the patient has a mild fever (99.4°F), the first such instance during her stay.
• 😀 Lungs were initially clear, but a non-productive cough and diminished lung sounds have since developed.
• 😀 The patient is experiencing chest pain and anxiety, which intensified during transport, although her initial EKG was negative.
• 😀 A verbal order for a heparin drip was placed, and the doctor needs to sign off before starting it, along with a second IV to be placed.
• 😀 After stabilizing oxygenation, Miss Claire will need to undergo a CT scan to rule out a pulmonary embolism (PE).

Q & A

What is the purpose of the ISBAR framework in this scenario?

The ISBAR framework is being used to provide a structured handoff report. It stands for Identification, Situation, Background, Assessment, and Recommendation, ensuring clear and organized communication between healthcare providers.

What are Miss Claire's primary symptoms that raised concern?

Miss Claire's primary symptoms include shortness of breath, rapid breathing, oxygen saturation dropping to 86%, cyanosis, chest pain, anxiety, and non-productive cough, which are concerning for a possible pulmonary embolism.

What specific changes were made to Miss Claire's oxygenation management?

Her oxygen was increased from 2 liters to a Venturi mask at 40% to maintain her oxygen saturation between 89% and 92%.

What is Miss Claire's medical history that could contribute to her condition?

She has a history of mild asthma, surgery for melanoma tumor removal, and long-term use of birth control for 15 years, which could be a risk factor for blood clots, making her susceptible to a pulmonary embolism.

Why is there suspicion of a pulmonary embolism in this case?

The suspicion of a pulmonary embolism arises due to Miss Claire's symptoms, such as sudden shortness of breath, chest pain, rapid breathing, and a history of birth control use, which is a known risk factor for clots.

What lab result was received, and how does it contribute to the diagnosis?

A high D-dimer result was received, which is often elevated in the presence of a blood clot, further suggesting the possibility of a pulmonary embolism.

What medications and treatments has Miss Claire received so far?

Miss Claire received a low-dose prophylactic injection of anoxaparon (an anticoagulant), and there is a verbal order for a heparin drip, pending doctor approval.

Why is a second IV necessary for Miss Claire?

A second IV is needed to administer the heparin drip once approved, as it is required to manage her condition while she awaits further diagnostics, including a CT scan.

What was the condition of Miss Claire's EKG, and why is it important?

The EKG performed in the ER was negative, meaning no signs of acute cardiac events were found, which helps rule out other causes for her symptoms, such as a heart attack.

Is there any concern about Miss Claire's kidney function regarding the planned CT scan?

No, Miss Claire's last creatinine level was 1, which is within the normal range, indicating her kidneys are functioning well enough to handle the contrast required for the CT scan.