Case Study:

Select each of the topics and charts to view the handover information on .

Current situation

is self-ventilating on air. She is also attached to a cardiac monitor on transfer which shows:

Heart rate: 115 beats per minute
Last BP: 95/50 mmHg
SpO₂: 94%
Respiratory rate: 24 breaths per minute

History of the situation

The nurse states that was found collapsed, having fallen on the floor at home, at 17:00 by her daughter Alice who was dropping off her mother's shopping.

Feeling unwell for last 3 days, started on oral antibiotics by GP for a possible Urinary Tract Infection (UTI) but has been feeling worse.

Past medical history

is a smoker and uses inhalers.

She has arthritis in her knees which limits the distance she can walk and is on regular analgesia.

Ability to be independent

manages independently around the house but struggles to do activities like food shopping.

was admitted to the department at 17:50. She required 500 mL of Hartman's stat and is currently having a second fluid bolus of 500 mL. This is running over 4 hours through a pink cannula sited in her left wrist.

Chest x-ray and arterial blood gas (ABG) undertaken in ED.

Urinalysis undertaken; nothing abnormal detected (NAD).

Sputum specimen sent to labs for analysis.

Effect of treatment in ED

Her systolic BP has increased and she is not as tachycardic now.

Temp 38.4°C - blood cultures have been taken. Tazocin is given. Nebulisers salbutamol and atrovent administered for a slight wheeze with good effect.

is aware of what is happening and was incontinent once when she first arrived in ED.

Blood Gas Result

Arterial Sample
Time: 18:30

pH	7.2
pCO₂	3.5 kPa
pO₂	10 kPa
HCO₃	16 mmol/L
Lactate	1.8 mmol/L

Handover from Emergency Department

Observations Medicines Fluid Balance Blood Results

MEDICINE PRESCRIPTION AND ADMINISTRATION RECORD
WARD Emergency Dept. WARD __________ WARD __________			CONSULTANT ____________________		DATE OF ADMISSION		NAME: AGE: HOSPITAL NUMBER: NHS NUMBER:
Card No 1 of 1		Chart rewritten By _____________ Date ________________________ Pharmacy check By _____________ Date ________________________			Weight _______(kg) Date ____________ Weight _______(kg) Date		NAME: AGE: HOSPITAL NUMBER: NHS NUMBER:
DRUG ALLERGY or ADVERSE EFFECT Medicine/Other Signature				If none know tick box [✔] Effect Date This section must be completed and signed by a prescriber or Pharmacist
ONCE ONLY MEDICINES
Date	Medicine	Dose	Route	Administration Instructions	Time Required	Prescriber's Sig, Print Name & Bleep	Time Given	Given By	Checked By	Pharm
	Tazocin	4.5g	I.V.	Give Immediately	18.00	A.BRN 1234	18.15	JE	AM
	Salbutamol	2.5mg	neb		18.00	A.BRN 1234	18.15	JE	AM
	Atrovent	500mg	neb		18.00	A.BRN 1234	18.15	JE	AM

Patient Details Patient Name: Age: Hospital Number:				FLUID CHART DATE: WARD: Emergency Dept.
INPUT (mLs)						OUTPUT (mLs)
Time	Intravenous fluid	Other (write)	DRUG (write) Noradrenaline	Hourly total	Running total	Urine	Hourly total	Running total	Balance (+ve or -ve)
01:00
...
18:00	500					++ incontinent
19:00	500	30 (tazocin)		1030	1030				+ve 1030
20:00	500, 500			1000	2030				+ve 2030
21:00
22:00
23:00
24:00

Patient Details Patient Name: Age: Hospital Number:				FLUID CHART Part One \| Part Two DATE: WARD: Emergency Dept. PREVIOUS DAY'S BALANCE: +ve 2533
INPUT (mLs)						OUTPUT (mLs)
Time	Intravenous fluid	Other (write)	DRUG (write) Noradrenaline	Hourly total	Running total	Urine	Hourly total	Running total	Balance (+ve or -ve)
01:00	250		10	260	260	30	30	30	+ve 230
02:00	250		10	260	520	35	35	65	+ve 455
03:00	250		10	260	780	40	40	105	+ve 675
04:00	250		10	260	1040	15	15	120	+ve 920
05:00	250	500 Hartman's	10	760	1800	25	25	145	+ve 1655
06:00	250		10	260	2060	30	30	175	+ve 1885
07:00	250		10	260	2320	30	30	205	+ve 2115
08:00	250		10	260	2580	20	20	225	+ve 2355
09:00	250		10	260	2840	10	10	235	+ve 2605
...

Haematology and CoagulopathyClinical Chemistry and Liver Function Tests
Test	Normal Values	18:30	20:15	06:00
HB	11.5 - 16.5 g/dL	10.0
Platelets	150 - 450 x 10^-9/L	120
WBC	4.0 - 11.0 x 10^-9/L	14.0
MCV	84 - 102 fL	85
Neutrophils	2.0 - 7.5 x 10^-9/L	9.0
ESR	1 - 20
APTT Ratio	0.85 - 1.14
INR	0.8 - 1.2
Prothrombin Time	10.0 - 12.0 sec's	12
APTT	21.0 - 29.0 sec's	32
Thrombin Time	17.0 - 21.0 sec's	21
D-Dimer	0 - 250 µg/L	200
Fibrinogen	1.8 - 4.0 g/L

Clinical Chemistry and Liver Function TestsHaematology and Coagulopathy
Test	Normal Values	18:30	20:15	06:00
Sodium	134 - 145 mmol/L	140
Potassium	3.5 - 5.3 mmol/L	4.5
Urea	2.9 - 7.5 mmol/L	10.0
Creatinine	45 - 84 µmol/L	100
GFR	(ml/min)
Glucose	4.0 - 8.0 mmol/L	9.9
Amylase	0 - 110 U/L
CK	25 - 200 U/L
ALT	0 - 35 U/L	30
γGT	0 - 40 U/L	50
Bilirubin	0 - 21 µmol/L	40
Alk Phosphate	40 - 130 U/L	180
Albumin	30 - 50 g/L	24
CRP	0 - 10 mg/dL	110
Troponin	up to 0.1 µg/L
Bicarbonate	24 - 32 mmol/L
Calcium	2.2 - 2.6 mmol/L
Phosphate	0.8 - 1.45 mmol/L
Magnesium	0.7 - 1.0 mmol/L

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