Sound Rationale s for Each Component of the Case Study

Excerpt from Case Study :

sound rationale(s) for each component of the primary survey that the Registered Nurse will undertake.

The geriatric male patient was admitted to the Emergency Department under triage supervision. Primary survey assessment (Considine, 2011) determines the patient's immediate physical condition pertinent to life or death. These include the patient's Airway, Breathing, Circulation, Disability, Discomfort. The patient scores a 14/15, which indicates his eyes are open, appears oriented with succinct and clear verbal responses, and displays exacting and swift motor response and coordination.

Patient respiration is accelerated with shallow yet painful breathes. Lung capacity appears to be compromised, unsure of whether the left or the right is specifically effected but perhaps the onset of pneumonia is the thought. Blood pressure is low, rapid and painful breathing coupled with low blood pressure are symptomatic and are important to monitor for further changes.

Pulse of 90 bpm is somewhat rapid and irregular with 90% oxygen received from room air, temperature of 99.68 F. Pale skin is consistent with low blood presume, perhaps soft pitted skin and noticeable bruises to the limb area and low blood circulation evidenced by cool peripheries such as the phalanges and tarsal/metatarsal. Patient experiences nausea.

Question 2

Identify the components of secondary survey that are required to be undertaken by the Registered Nurse for Mr. Thomas and provide the rationale(s) for each component.

The secondary survey seeks to ascertain vital problems that primary survey tactics did not assess. The patient is assessed for exposure, freezing, the vital signs, a full head to toe assessment, a patient history, and back inspection (Considine, 2011). The patient does appear to have been suffering from exposure due to the cold extremities, the rapid and painful heartbeat. The exposure does not appear to be for a long duration as the blood pressure is not accelerated and consistent with the respiratory rate. The patient is on pain and heart medication and is reported to be potentially suffering from a cold.

The head to toe assessment reveals head trauma via a large laceration that releases blood loss from the left side. Patient also has a large gash on the tongue and is bleeding from this injury. Oral discomfort and general physical discomfort is anticipated due to the chipped teeth and sore wrist suffered from the fall including the grazes on arms and chest, which ooze blood.

Question 3

Identify presentation assessment and history findings specific to Mr. Thomas' fluid status and provide physiological rationale(s) for these data.

Mr. Thomas' fluid levels appear to be low, certainly blood loss has occurred and therefore blood fluid levels are low and critical as the heart is not pumping adequately to replace the lost blood sufficiently while the lacerations and gashes are not sutured. The physiological stiumuli to the patient thirst center is due to the lower blood volume evidenced by the low blood pressure but notably by the low diastolic level.

Question 4

Provide physiological rationale(s) or the impact Mr. Thomas' medications may have on his presentation assessment findings. Include in your answer a brief outline of the action of the relevant medication(s).

Mr Thomas' is highly medicated and does not feel the physical pain to the level that one that is not as medicated will report feeling. This is the reason for his response as not wanting to be admitted to the hospital as he does not feel his injuries to be severe. The presentation regarding assessment findings are somewhat distorted due to the medication reaction in Mr. Thomas' body both physiological and psychological.

Aspirin 100mg: This dosage of aspirin will thin the patient's blood and lower the blood pressure. The aspirin will additionally reduce the likelihood of a heart attack or stroke and will reduce the level of pain experienced by the sustained injuries.

Clopidogrel 75mg: Has the additional benefit of preventing heart attacks and strokes but when taken with aspirin will reduce pressure drastically and perhaps dangerously.

Ramipril 5mg: Another medication that treats high blood pressure with the intent to reduce the risk of heart attack and stroke. The drug interaction between these medications can cause side effects and physiological interactions that are highly unpredictable.

Atenolol 25mg: Another high blood pressure medication is used to prevent conditions associated with reported cases of angina and to improve survival rates after a myocardial infarction.…

Sources Used in Document:


Considine D. (2011) Patient assessment Primary and secondary survey. Deakin University-Northern Health Clinical Partnership

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