Class 6 Unit 3 Topic 1 Comment 1

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

No errors with APA format 6 Edition

To Comment:

Case 1

The patient, Yolanda Pinellas, is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy.  Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. An infusion machine was used for the delivery. A night shift RN that was assigned to Yolanda for that shift hung the Mitomycin. They had worked a double shift the day before and had to double back to cover the evening shift. This is a very sad reality that is affecting all us as nurses.  We are working harder and going above what is being asked of us, the administration is making money and we are putting patients at risk.  In Concern for Safe Staffing Form Annual Report 2015 by the Minnesota nursing association “found nurses reported 2,741 incidents of unsafe staffing in Minnesota hospitals in 2015, an increase of 32.93 percent over 2014” (Brady, 2016, p.12).  This is not only happening in Minnesota.  I know I have been asked to take one more patient than my assigned caseload and this puts patients at risk.  I feel that I am giving substandard patient care; these include delays in treatments or medications, inability to answer call lights, and incomplete discharges or assessments.  I am told to turn patients over in the rooms since we have another one waiting.   

On the evening shift, the infusion pump beeped several times. LPN ignored pump, thought someone else was caring for the patient. An RN responded to the patient’s call bell and found the IV had been dislodged from the patient's vein. There was no evidence that the Mitomycin had gone into the patient's tissue. The RN immediately stopped the IV, notified the physician, and provided care to the hand. The documentation in the medical record indicates that there was an infiltration to the IV. This is something that can be avoided, Thakur, Chauhan, Diwana, Chauhan, and Thakur (2008) recommended:  

All the emergency drugs and antidotes should be kept at the patient’s bedside. The infusion should be started in the forearm as the muscles will protect the nerves and vessels from injury in case of extravasation. The use of veins on the dorsum of the hand, wrist, and cubital fossa can lead to injury to the nerves, vessels, ligaments, and bones during extravasation as these structures lie without any protection from muscles in these areas. First, run normal saline or 5% dextrose in the intravenous line. This will not only hydrate the patient-a prerequisite for chemotherapy but will also be confirmatory for the proper placement of the cannula in the vein of the fluid will not run at full speed in case of improper placement. If possible, use a central venous catheter for infusion. Avoid the use of high-pressure infusions (p.149).

These are all things that the first RN could have tried to prevent issues with the chemo drug getting into the patient's tissue. 

Two weeks after the event, the patient developed necrosis of the hand and required multiple surgical procedures, skin grafting, and reconstruction. She had permanent loss of function and deformity in her third, fourth, and fifth fingers. The claimant is alleging that, because of this, she is no longer able to perform as a conductor, for which she was studying.  This patient is in the rights to file a malpractice suit for lost wages and damages.