Question

Handoff report at 0800. Young man transferred from ICU for a motor vehicle accident 14 days ago. Head trauma, subsequent evacuation of subdermal hematoma. Currently unconscious, unresponsive to painful stimuli, flaccid extremities. Pupils round, sluggish reaction to light. Abrasions on face, bruises on shoulder and chest. VS: T 98.9°F, P 94, R 24, BP 124/80, pulse ox 94%. Mother at bedside, questions everything you do.

2:00 PM nursing assessment: Pupil round R ● L ●nonreactive to light. R 12 Cheyne-Stokes, P 80, BP 150/80. Skin warm, jerky movements of the upper extremity noted. The physician writes the following orders:
Oxygen at 12 L/min per non-rebreather mask
Check oxygen saturation q1h
Vital signs q1h
CT scan of the head stat
ABGs stat

Using ISBAR, write how you will communicate with the patient’s primary health care provider/physician over the phone?

I	Identify	Self – name , position, location Patient – name, age, gender
S	Situation	Explain what has happened to trigger this phone call conversation
B	Background	Admission date, diagnosis, relevant history, investigations, what has been done so far
A	Assessment	Give a summary of the patient’s condition or situation. Explain what you think the problem is (if you can)
R	Request / Recommendation	State your request or recommendation

Answer 1

Identify

Introduce about self like name,designation and place of call.Then inform about patient stating his name,primary physician with diagnosis ,age ,gender, ward

Situation

Explain that the patient vital signs are altered that is respiratory rate us 12 with cheyne stoke respiration,,pupil non reactive to light,jerky movement noted in upper extremity

Background

Dx: Subdermal hematoma

Relevant history : motor vehicle accident

Assessment

• The patient is bradypenia
• experiencing cheyne stoke respiration
• the patient condition is detoriating and needs immediate intervention
• Inform oxygen saturation

Recommendations

• An immediate oxygenation is needed for the patient
• respiratory stimulants to improve his breathing pattern
• intensive heart failure treatment
• Continuous Positive Airway Pressure