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Handoff Report to a student about a Patient with a Spider Bite
Avatar Roles Marc, a registered nurse
Mary Ann, a registered nurse who interrupts report
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Event Script
Marc is sitting at the nurses’ station giving a verbal patient report to the student.
He glances back and forth at computer screen as if he is shifting from reading the information on the screen to looking at the student.
Marc: Today you’ll be caring for Thomas Jones, a 28 year old patient of Dr.
Higgins. Mr Jones was admitted 4 days ago for what the doctor thinks is an insect bite from a brown recluse spider while he was camping in the mountains.
Yesterday, the surgeon took him to surgery to clean the wound on his left thigh, so now there is an open wound there. He is a non-smoker, occasionally drinks alcohol, and has no other significant medical history. He lives with his girlfriend who has been with him here most of the time.
He’s a full code and has no known allergies.
He’s on q 4 hour vital signs & his most recent vital signs, taken about 30 minutes ago are:
Temperature 100.8 Pulse 84
Respirations 26 Blood pressure 124/70 As far as his physical assessment:
Neuro: he is awake, alert, oriented times 3, his speech is clear; he has no vision or hearing deficits.
Cardiovascular: S1 & S2 are audible, regular rhythm, rate of 84; Peripheral pulses are palpable, strong, and equal bilaterally. Skin is pale, beige, no skin breakdown. He does have +1 edema in the left foot & leg.
There is an IV in his right arm of D5 1/2 normal saline with 10 milli-equivalents of potassium chloride. It was inserted 2 days ago.
Respiratory: respirations are even, unlabored at 18 breaths per minutes. Breath sounds are clear throughout and he’s on room air. His oxygen saturation level was 99%.
GI: His abdomen is soft, non-distended, with positive bowel sounds. His last bowel movement was yesterday and he reports that as being normal. He’s on a
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Mary Ann enters the report handoff area, looks at Marc, and says…………
Marc looks at the Mary Ann Marc goes back to giving report.
regular diet and is eating about 100% of his meals.
GU: He is voiding adequate amounts of clear yellow urine in the urinal.
Mary Ann: Marc, your patient, Thomas Jones just called the desk and said he needs to have his pain medicine.
Marc: Oh-okay, thanks.
He last had his pain medicine 6 hours ago. He gets IM Morphine 2 milligrams, it is ordered for every 4 hours prn. I gave it in the left ventro-gluteal site. After he received his pain medicine yesterday, he tried to get up and go to the bathroom and fell. The doctor was notified and there were no apparent injuries.
So he was put on fall precautions that need to be reinforced.
Skin: Skin turgor is brisk, there are no other lesions or skin problems. He has the dressing on his left thigh that is dry and intact and it is due to be changed at the beginning of your shift.
The orders are to do a wet to dry dressing with normal saline TID.
The wound bed is open, beefy red, no odor and has minimal serousanginous drainage.
Musculoskeletal: He has full range of motion with limited movement in that left leg. As I said he is a fall risk since he fell yesterday.
That’s it for him. Do you have any questions?
Okay, well please just follow up on his request for pain medication. Have a good shift and I’ll see you tomorrow.