Incident, Problem, and Solution Assignment

Nurse Team Rounds

Welcome Nurses to this week’s Team Rounds. Today, we have TWO tasks to complete.
Task 1: Review the image below and describe the incident, noting both basic and advanced
physical description criteria. Point form documentation is accepted.

I have started the description for you…

- Four health care professionals in PPE.
Task 2: Read the narrative below that describes a sample scenario in a hospital Emergency
Room. Identify at least THREE incidents/problems that occurred in the reported scenario.
Explain why and how you think they are incidents/problems, and then offer suggestions on
how to solve each incident/problem. Complete sentence structure is required.
James is an ER triage nurse at Trillium Health Partners in Mississauga, Ontario. On Monday,
April 24th, 2020, James reported to work at 7:00am. On this particular day, he was working
with his RN colleague Melissa, who had to take a double shift because Richard (the RN who
typically works Mondays) was ill.
At roughly 8:30 am, a patient named Charles Becker enters the ER, grasping his right shoulder.
He approaches James’ desk.
“Hi there,” remarks Charles, who is seemingly in pain.
“Hi. What brings you to the ER?” asks James.
Charles explains that he was involved in an accident at home, whereby he fell from his porch
and landed on his shoulder, which he thinks is now dislocated or broken.
“Ok, let me take your temperature and blood pressure,” says James, preparing the
instruments.
“Nurse, can I please have some Tylenol or something. It hurts,” inquires Charles.
“I will go double-check with the doctor,” assures James. “No fever, so that’s good. Your blood
pressure will show in a second.”
Melissa joins them in the room, hunting intently for her eyeglasses that she left there earlier.
“Hey Melissa,” says James, “do me a favor and record Charles’ blood pressure. I have to ask
the doctor something quickly.”
Rushed, Melissa notes 133/88. It actually reads 188/98. Normal blood pressure is roughly
120/80. She then remembers leaving her glasses in the bathroom when she washed her face.
“Hey, Doctor Fleming,” says James. “Quick question for you. There’s a-“
“Mr. James,” Doctor Fleming interrupts, “do you not see that I am reading an MRI report? As a
nurse, you should recognize the importance of not distracting us physicians when doing
important duties such as these.”
James is furious and embarrassed at the same time. He remains silent and begins to walk
away.
“Wait,” Doctor Fleming remarks. “What is it now that you are here?”
“An ER patient is requesting medication for pain. It looks like he dislocated his shoulder. Can I
give him anything in the meantime?”
“Acetaminophen is fine, James,” responds the doctor. “I will go speak with the radiologist
upstairs for a minute. I’ll be back in a few.”
James returns to the triage area. He gives Charles two extra-strength Tylenol caplets and a
bottle of water. Charles returns to the waiting room.
After 15 minutes, Melissa calls out, “Charles, you are next.” Charles rises from his chair and
quickly collapses to the ground. He begins to seize violently.
Melissa runs towards Charles, “James, get over here, please.” James joins Melissa with some
medical instruments to attempt to settle Charles.
“What the hell happened?” James asks as he straps the blood pressure machine cuff on
Charles. “195/125! He is in hypertensive crisis! How can this be? Melissa, what was his bp
earlier?”
Melissa responds, “I don’t remember exactly, but something stable like 130/85. Wait, let me
check the machine’s memory data.”
188/98.
“If it was that high, to begin with, then… oh no… the Tylenol! Acetaminophen will increase
blood pressure,” James states with fear in his voice. James and Melissa know that Charles
needs medication to lower his blood pressure quickly before any organ damage began.
“Okay, I’ll get Doctor Fleming in the back,” Melissa says.
“He’s not there. He went upstairs to radiology. We don’t have time, Melissa. Just get the
clonidine and captopril now!” yells James.
Melissa stutters, “B-b-b-but James… we can’t. You know that… I mean, look what just
happened because we didn’t double-check.”
Just then, Doctor Fleming turns the corner from the elevator exit. He orders the administration
of clonidine and captopril. Charles comes out of the seizure and is immediately admitted for
continued care.
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