Show
Design a Triage Training Program that results in measurable change. For implementation best practices:Acute Coronary Syndrome (ACS)One of the greatest impacts on triage processes has been the ability to rapidly identify patients at risk for STEMI (ST elevation myocardial infarction) and other acute coronary syndromes. Adults over 30 years of age with non-traumatic chest pain should prompt the triage nurse to consider the possibility of ACS. There are distinct risk factors that position a patient for a greater risk of ACS. These risk factors are well known to the public, as they have been taught for more than 20 years to all age demographics by the American Heart Association.
Questions aimed at identifying the patient with possible ACS:
While recognizing risk factors in the presenting patient with chest pain/dyspnea, the triage nurse must also consider the following:
Pulmonary EmbolismPulmonary embolism (PE) most commonly originates in the calf; it occurs as a complication of venous stasis and other factors. The presence of embolus in one or more arteries of the lung creates a scenario of decreased cardiac output. Even though the clinical symptoms and signs of pulmonary embolism are very non-specific, research and retrospective review from patient autopsies reveal patients who are at the greatest risk for developing PE.Questions aimed at identifying the patient with a possible PE (ask the following questions in addition to the questions above for possible ACS):
Don’t fall into common triage pitfalls that result in poor patient outcomes related to PE:
Spontaneous PneumothoraxAir or gas can enter the pleural cavity through a variety of mechanisms; some are related to injury, others occur spontaneously. Its presence will interfere with oxygenation and at times ventilation; the impact will be dependent on the size of the disruption. The patient does not always have an underlying lung disease that creates the pneumothorax. In the absence of any underlying clinical causes in the presence of pneumothorax, this patient is known as primary spontaneous pneumothorax (PSP). It is usually the rupture of a bleb or bullae that causes the spontaneous pneumothorax.A patient with underlying pulmonary pathology (SSP - secondary spontaneous pneumothorax) from lung disease has distended and/or damaged alveoli through which air can travel and enter the pleural space. Questions aimed at identifying the patient with a possible spontaneous pneumothorax:
Thoracic Aortic AneurysmAn aneurysm is a localized or diffuse dilation of an artery with a diameter that is at least 50% greater than the artery’s normal size. Although most aortic aneurysms occur in the abdomen, deaths due to thoracic aortic dissection (TAD) are twice as common. Questions aimed at identifying the patient with a possible dissecting TAD:
Pacemaker MalfunctionApproximately 200,000 pacemaker devices are implanted in patients in the United States each year. Although the technology related to pacemakers continues to advance, malfunctions may still occur. There are many causes for malfunction or failure of a pacemaker. The extent of the pacemaker malfunction and how well the patient does or does not compensate will impact the severity of the potential for demise. An additional consideration for the triage nurse is the length of time the patient has been experiencing symptoms. An immediate ECG is always indicated to ensure that the patient is not having ST or other cardiac issues aside from the pacemaker. A patient who has had an uneventful course related to their pacemaker often discounts the pacemaker as a source of symptoms; a delay in care for what started out as simply a “dizzy spell” can lead to major perfusion concerns in a short period of time. Questions aimed at identifying the patient with a possible malfunctioning pacemaker:
More than 7 million patients present to an emergency department each year with chest pain and related symptoms (this does not take into account the unknown volume of patients with these complaints who present to urgent care facilities). With this high volume of patients, it is important for the triage nurse to ask the key questions that will identify patients at higher risk for serious underlying causes of their chest pain. Related Content:
ShareCategories: Diagnostic Error, Emergency Medicine, Triage, Urgent Care, Nursing What questions do you ask during a musculoskeletal assessment?History of Present Illness. Date of onset and type of onset (suddenly or slowly).. Location of pain: (joints, muscles, soft tissues). Presence of swelling* (before and now). Subsequent course (progressive, intermittent or remittent).. Present status (better, same or worse).. Impact on their lives.. What do nurses used to assess the musculoskeletal system?Also, a nursing health assessment of the musculoskeletal system involves palpation of the joints. Palpate the joints and assess the temperature of the skin and the muscles. Palpate for warmth, tenderness, swelling or masses. If pain or tenderness are noted, further assess to specify the joint or structure involved.
How do you assess the musculoskeletal system?Gently palpate bones, joints, muscles, and surrounding tissue for heat, swelling, stiffness, tenderness, or crepitation. Ask the patient to move major joints (knees, shoulders, hips, and ankles) through the expected ROM movements. Observe the quality and equality of motion bilaterally with the same body parts.
When inspecting the musculoskeletal system which elements of the patient's posture would the nurse assess?The nurse would assess the patient's muscle symmetry as part of a musculoskeletal inspection.
|