This paper reviews an emergency department nurse's management of a 28-year-old female patient found semi-conscious following a fall. Using a systematic framework, the paper evaluates the nurse's application of primary and secondary assessment protocols — including airway, breathing, circulation, and disability checks — alongside history-taking, vital sign interpretation, and head-to-toe examination. The review also explores the principles of patient-centered care, the role of nurses in healthcare quality and safety, and organizational factors contributing to human error in clinical settings. Drawing on established clinical guidelines and nursing literature, the paper highlights both strengths and gaps in the documented assessment process.
The patient is a 28-year-old female who was brought to the Emergency Department (ED) by her neighbor. The neighbor reported finding the patient lying semi-conscious in the shower. She was received in the ED by the on-call nurse. This paper reviews the nurse's performance in managing this patient's emergency presentation.
Emergency evaluation of a patient should be conducted in a systematic manner. A systemic approach prevents the examiner from overlooking important clues that may point to a diagnosis. This approach is divided into a primary assessment and a secondary assessment.
As part of the primary assessment, the patient's airway, breathing, circulation, and degree of disability were evaluated as per protocol. The patient's airway was patent, breathing was shallow, and her skin color was pink, indicating good perfusion. She was obeying commands and her pupils were equal in size and reactive to light. It is also helpful to document capillary bed refill time as part of the primary assessment (Gilbert, Souza & Pletz, 2009).
The secondary assessment is carried out after the primary assessment. It is systemic and complaint-focused. Relevant physical examination is conducted alongside a brief overall head-to-toe examination. The secondary survey may be done concurrently with obtaining the patient's history. Key steps before initiating a secondary survey include: conducting a rapid trauma evaluation, immobilizing the spine in the event of a suspected spinal injury, evaluating the patient's chief complaint, and calling for help. An initial set of vital signs is then recorded (Gilbert et al., 2009).
The patient's vitals reflected tachypnea, with a respiratory rate of 26 breaths per minute. Pulse was 94 beats per minute, blood pressure was elevated at 145/75 mmHg, and the patient remained afebrile. Oxygen saturation was 95% on room air. Analyzing vitals and oxygen saturation is a crucial component of immediate emergency assessment. The patient's general appearance is also part of the immediate assessment and can provide valuable information about the severity of the condition. Where pain or tenderness is present, a scale of 0–10 is used to quantify its severity (Gilbert et al., 2009). This aspect was described later in the assessment.
The patient was appropriately reassured by the nurse — an important step in relieving anxiety for all conscious patients arriving at the ED. Patients often enter the hospital with heightened feelings of stress, anxiety, and vulnerability, and the environment they encounter has the potential to exacerbate their original condition. Building processes and using mechanisms to personalize the patient experience is a key strategy for reducing fear and anxiety associated with a hospital visit (Canadian Medical Association, 2007).
The patient's chief complaint should have been documented immediately after obtaining vitals and reassuring the patient. In this case, it was described later in the head-to-toe examination section — an approach that may be justifiable in the ED, since history-taking and physical examination are often conducted simultaneously during emergencies (Gilbert et al., 2009).
A drug history, including drug allergies, was obtained early in the assessment — an important point to note. This information is critical in cases where patients require immediate life-saving medications or analgesics to relieve tachycardia. The patient is allergic to all sulfa drugs and is currently taking metoprolol 25 mg. Asking when she last took her medication would also be important, in order to rule out the possibility of a missed dose (Swash & Glynn, 2007).
Identifying risk factors and existing comorbidities is a critical next step, as these can alert the clinician to the nature of the primary complaint (Gilbert et al., 2009). The patient is a 28-year-old female with a known history of atrial fibrillation and ulcerative colitis. She is obese, with a body mass index of 41.1. She is also a smoker and consumes alcohol excessively, and has undergone a right hemicolectomy and an ileostomy in the past. The duration of smoking and excessive alcohol consumption — which was not mentioned in the assessment — is also relevant to her primary complaint (Swash & Glynn, 2007).
Assessing the patient's head injury is an important first step in the relevant examination. The injury was secondary to a fall, resulting in a laceration above her right eye and a right facial contusion. The patient was disoriented in both place and time and could not recall how the injury had occurred. She also complained of a headache. The correlation between trauma and the development of a headache points to the need for prompt investigation (Swash & Glynn, 2007).
The patient's primary complaint was severe epigastric pain radiating to the back, relieved in Fowler's position. Details of the pain and events preceding it were not documented. Important points would include inquiring about the onset, nature, and duration of the pain, as well as any precipitating factors (Swash & Glynn, 2007). Even though the patient's history is suggestive of severe pain with an acute onset, it remains possible that she had been experiencing a similar but lower-intensity pain prior to this acute episode.
"Abdominal findings and diagnostic differentials"
"Patient-focused model and three Cs of care"
"Nursing workforce, error models, and system design"
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