Question

A patient is in skeletal traction and has a plaster cast due to a fractured femur. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) A. Failure to document a change in assessment data B. Failure to provide discharge instructions C. Failure to provide patient education about cast care. D. Failure to use proper medical equipment ordered for patient monitoring E. Failure to notify a health care provider about a change in the patient's condition

Short answer

The applicable statements regarding a breach of duty in this situation are A. Failure to document a change in assessment data and E. Failure to notify a health care provider about a change in the patient's condition.

Step-by-step solution

Identify Changes in Patient's Condition

Review the patient's symptoms such as decreased sensation, cold feeling in the toes, and the toes becoming pale and cold. These changes indicate possible complications.

Recognize the Nurse's Actions

Consider the nurse's failure to document the change in assessment data, and the subsequent events leading up to the patient's surgery for amputation.

Determine Breaches of Duty Related to Documentation and Communication

Assess whether the nurse's actions constitute a failure to document a change in assessment data (A) and a failure to notify a health care provider about a change in the patient's condition (E), as these relate directly to the changes observed and the lack of documentation and communication.

Assess Irrelevant Options

Discard options B, C, and D as they do not directly relate to the situation described. Discharge instructions, patient education about cast care, and use of proper medical equipment do not pertain to the immediate issue of the patient's worsening condition and the nurse's inaction.

Select Applicable Statements

Choose the statements that are relevant to the breach of duty in this situation, which are option A and option E.

Key concepts

Nursing Documentation

Nursing documentation is a vital aspect of patient care and refers to the accurate and complete recording of all aspects of a patient's treatment and progress. It creates a legal record of the patient's care and serves multiple key purposes, including communicating important information to the team, supporting clinical decision making, and providing a basis for evaluating the effectiveness of interventions.

In the context of the exercise, the nurse neglected to record critical changes in the patient's condition, which is a fundamental breach of nursing duties. Proper documentation would have included noting the decreased sensation and change in color and temperature of the toes, as these are telltale signs of potential complications, such as compromised circulation that could lead to the need for amputation.

Importance in Legal and Clinical Aspects

Documentation in nursing also holds significant legal importance, as it can be used as evidence in court should a malpractice claim arise. Clinically, it can influence the continuity of care when multiple healthcare providers are involved. This ensures that any healthcare professional taking over can quickly understand a patient's history, treatment plan, and any concerns or changes in their condition that need addressing.

Failing to document changes not only impacts patient outcome but can also be considered negligent in the eyes of the law. It's imperative for nurses to understand the gravity of thorough documentation practices.

Patient Care Communication

Effective communication in patient care is crucial for the delivery of quality healthcare services. Communication in nursing encompasses all interactions with patients, families, and healthcare team members. This includes verbal exchanges, written reports, and any other form of message transfer that relates to patient care.

In our exercise scenario, there was a breakdown in communication when the nurse did not inform a healthcare provider about the patient's change in condition. Timely and accurate communication could have prompted an immediate re-assessment and potentially prevented the subsequent need for amputation.

Team Coordination and Error Prevention

Effective communication ensures that all team members are on the same page about a patient's condition, treatment plans, and any recent changes. It can significantly reduce the risk of medical errors. In emergency situations, like the one at hand where another patient was experiencing cardiac arrest, this becomes especially crucial for multidisciplinary team members to prioritize and coordinate care appropriately.

Nursing Assessment Monitoring

Nursing assessment monitoring is a continuous process aimed at understanding and predicting a patient's response to health conditions and treatment. Nurses are tasked with regular assessment of a patient's physical and mental status, monitoring vital signs, and detecting any changes in the patient's condition.

For the patient with a skeletal traction in our exercise, ongoing monitoring would include assessments of the affected limb for circulation, sensation, and movement. Detection of problems, such as those presented in the patient's toes, should prompt further investigation and immediate action.

Risk Management and Intervention Strategies

Nurses must use appropriate risk assessment tools and strategies to identify potential complications. Monitoring and assessment are not only about observing but also about acting on those observations. In the given case, the nurse's failure to do so led to a deterioration in the patient's condition, demonstrating a clear breach of duty in terms of assessment monitoring.