What interpersonal and situational factors influenced how this scenario transpired?

In this scenario the nursing student did every task she had been asked to do. Should anything else be expected of students?
2. What interpersonal and situational factors influenced how this scenario transpired?
3. How might the outcome of Mr Esposito have been different had Maddie had a requisite level of clinical reasoning skills?
4. What aspects of this adverse drug event were preventable?
5. Should this adverse drug event be documented and reported? If so, where, by whom, to whom and why?
6. The medical officer and nurse discussed whether Mr Esposito and his daughter should be told that he had experienced an adverse drug event. The nurse thought they should be told, but the doctor disagreed saying that telling Mr Esposito and his daughter would make them worry needlessly. What do you think and why?
7. Reflect on the scenario and outline some of the errors that occurred and that led to Mr Epsositos adverse drug event.

Mr Guiseppe Esposito, 81 years, was admitted to the medical ward of Griffith Community Hospital with dehydration as a result of suspect gastroenteritis. He had been vomiting and had diarrhoea for two days prior to admission. Intravenous fluids were commenced and his diarrhoea began to improve the following day, although some nausea persisted. Mr Espositos IV was not resited when it ‘tissued later that evening.
At 000 the next day (Guiseppes second day following admission) Maddie was asked to administer Guiseppes usual oral medications (frusemide 80 mg, digoxin 125 micrograms and enalapril 20 mg). It was a busy shift and the registered nurse (RN) supervising Maddie was interrupted and asked to attend to another r patient. She said, ‘Keep going – Ill watch what you are doing from over here. Maddie, although new to the ward and feeling quite intimidated, was conscious that this was outside of her scope of practice. She said, Im sorry but I am not allowed to administer medications without direct supervision by a registered nurse. The RUN looked surprised but said, ‘Oh … Okay, Ill be there in a tick. While she waited, Maddie checked that there was a valid order for the medications and reviewed the ‘Australian Medicines Handbook, (Rossi 2011) to find out more about the medications following the ‘six rights (right patient, right drug, right dose, right time, right route, right documentation); she also checked to see if Giuseppe had any allergies. Maddie asked him to check his medications as she gave them to him, saying, ‘Im giving you your Lanoxin, Lasix and Renitec, is that right? Do you know what theyre for, Giuseppe? He nodded and replied, ‘Yes, yes, theyre for my ticker and my water.
Read the above continuation of the scenario about Mr Esposito and answer these questions about medication safety and administering medications.
What other ‘rights are essential to medication safety?
1. What does a valid medication order require?
2. What three checks are required when administering medications?
3. Should Maddie have taken Giuseppes vital signs prior to administering his medications?

1 CONSIDER THE PATIENT SITUATION
In the first stage of the clinical reasoning cycle the nurse begins to gain an initial impression. He or she takes notive of the patients concerns and begins to thing about the situation. Whilst Maddie interacts with Giuseppe, Giuseppe tells her ‘Geez, Im a bit dizzy, girly. Maddie was not sure of what to do, but decided to leave him sitting for a while as she was concerned that if she took him to the shower he might fall.
2 COLLECT CUES / INFORMATION
During the second stage of the clinical reasoning cycle the nurse begins to collect relevant information that is currently available in the patients clinical documentation, medical and nursing notes, handover report, or other available information.
As Maddie began to think about why Giuseppe was feeling dizzy, she reviewed his charts. The fluid balance chart was incomplete, as it had not been maintained since the IV tissued the previous day. Maddie noticed that on the previous day Giuseppe was in a positive balance (2400mL in – mostly IV fluids and small amounts of oral fluids; total output 700 mL – he had been voiding small amounts infrequently).
Giuseppes observations had been relatively stable, but his pulse rate seemed to have decreased in the days since admission. Maddie was not sure what this meant. Giuseppes blood pressure had been between 120/70 and 110/60. His temperature had been 38oC on admission but 36.4-37oC over the last 24 hours. Giuseppes respiratory rate had been 16-20 resps per minute. There was no mention in the progress notes of Giuseppe feeling dizzy previously.
a Gather new information
The next stage of the clinical reasoning cycle is to collect relevant cues and information. This requires the nurse to determine which cues are relevant for a particular person at a particular point in time. Maddie considered Giuseppes dizziness and decided to take his blood pressure sitting and standing before getting him up for the shower. She used the manual sphygmomanometer attached to the wall beside his bed.
1. Why did Maddie take a sitting and a standing BP?
2. Why do you think Maddie chose to use the manual sphygmomanometer instead of the electronic one?
3. Giuseppes blood pressure was 120/70 sitting and 110/60 standing. What might this reading indicate?
Maddie also checked Giuseppes pulse rate; it was 64, weak and thready, and irregular. She confirmed this finding by checking Giuseppes apical pulse for 60 seconds using a stethoscope. Taken apically Maddie thought his pulse rate was 68 and very irregular.
1. Why did Maddie check Giuseppes apical pulse?
2. From the list below, identify the other cues that you believe Maddie should have collected?
a Appetite
b Condition of oral mucosa
c Oral intake
d Pain
e Cognitive state
f Colour
g Skin condition
h Level of thirst
1. Are there any other cues that Maddie should have collected at this time?
2. Are there any questions you would have asked Giuseppe if you had been in this situation?
b. Recall knowledge (quick quiz)
While cue collection involves reviewing current information and gathering new information, it also requires you to recall related knowledge. This includes a broad and deep knowledge of physiology, pathophysiology, pharmacology, epidemiology, therapeutics, culture, context of care, ethics and law and so on, as well as an understanding of evidence-based practice.

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