Question

A patient on your team is experiencing difficulty breathing. There is no change in the patient's status after you elevate the head of bed, apply oxygen, have the patient use pursed lip breathing, and obtain a breathing treatment for the patient. Auscultation of the lungs demonstrates crackles bilaterally halfway up the lungs. The respiratory rate is 40 breaths/min, with an oxygen saturation level of 90% on 4 liters oxygen per nasal cannula. The patient is restless and having difficulty speaking because of the shortness of breath. After exhausting all nursing interventions, you call the physician by telephone regarding the change in patient's status

1. Describe how you would communicate the following areas using the I-SBAR-R tool. Identification, situation, background, assessment, recommendation/read back/or response.

The physician orders Lasix 40 mg IVP and morphine 4 mg IVP and 1 to 2 mg IVP every 1 hour prn. You write down the telephone order and hang up. Your transcription includes the following information:

Lasix 40 mp IVP Stat and QD

MSO4 4.0 mg IVP Stat and 1.0-2.0 mg IVP q1hr prn

2. Is this the correct transcription of the order? How would you change it?

3. What tips for communicating with physicians on the telephone can you recall from the textbook chapter? Which of these were missing, done incorrectly, or not done during the communication with the physician? Which steps still need to be done?

Answer 1

ISBAR:

Introduction:

Identify yourself ( name, told, location) and give reasons for call

I am calling because of ......

Situation:

Give patient name, age, gender...

Explain current status of patient

Background:

Tell detail history of patient and complete finding of physical assessment.

Assessment:

Put together patient current needs, current condition, risk and other factors.

What's your final assessment.

Recommendation:

Be clear about what you are expecting?

Like treatment, transfer etc

When should it happen?

Question 2

No, its not a correct prescription.

Rational:

a. Inj.Lasix 40 mg van be given as state dose in this situation,

But continue with QD is depending upon patient condition.

If the urinary output is good, then we can continue the dose, still its depends on electrolyte status of the patient.

b.Inj. Morphine 4mg can be given in IV state, but continue the dose is unnecessary. Cause respiratory depression.

How to change:

a. Make call to the physician and explain the effects of this drugs, size effects and change the prescription.

question 3:

a, be clear about patient condition with presents complaints

b. Review the treatment chat thoroughly.

c. Collect evidence on reason for changing the dose

d. If you ready with this make call to physician

e. Explain all facts one again to the physician

f. Tell the need for changing the dose.