Tips for ED Patient Profile
*The examples provided are SUPERIOR work.
Assessments:
Include ALL body systems with a focus on the MOST important for the patient complaints.
Be DETAILED – Do not say WNL.
Example of 1 Body System: RESPIRATORY: (lung sounds, work of breathing, O2 sat)
The patient’s lung fields are clear in all lobes bilaterally with no evidence of adventitious lung
sounds upon auscultation. The patient currently has non-labored, regular breathing with a SpO2
ranging from 95% - 99% on room air. The patient initially had snoring respirations that were
below the normal limits of 12 bpm, but those were corrected following the administration of
Narcan. The patient has continually had increased respirations within normal limits from 12 – 20
bpm during his stay in the ED. There was no evidence of use of accessory muscles for breathing.
Upon inspection, the patient’s anterior/posterior diameter is symmetrical and there appear to be
no structural abnormalities of the rib cage. The patient did not report if he had obstructive sleep
apnea.
Patho Section:
1) You must have 1 MAIN diagnoses and 3 DIFFERENTIALS if available OR 4
DIFFERENTIALS
2) Discuss the patho for EACH differential down to the cellular level
Example: Ischemic strokes are a result of inadequate blood flow to the brain due to an occlusion
of one of the arteries that supply the brain tissue. It can be a complete occlusion or a partial
occlusion. There are two types of ischemic stroke: thrombotic or embolic. Men have a higher risk
of ischemic strokes then women do. In a thrombotic stoke, a blood clot forms in one of the
cerebral arteries that blocks the flow of blood to the tissue distal of the clot. Atherosclerosis is a
leading cause of the development of a thrombus in a vessel (Tan & Christensen, 2012).
Atherosclerosis is the build-up of fatty plaque in an artery. It is a process that occurs overtime
with the deposition of fatty streaks and lipids along the lining of the endothelial wall. Initially,
smooth muscle cells are filled with lipids that flow through the coronary arteries. As they
accumulate to abnormal levels, they can cause damage to the endothelial lining of the vessel.
These injuries are typically repaired immediately on its own. Due to the high number of lipids in
the body, growth factors are released from platelets that have accumulated at the site of injury.
The smooth muscle proliferates as well and the arterial wall is thickened. Lipoproteins transport
cholesterol to the sight of endothelial injury and collagen then covers the fatty streaks to form a
fibrous plaque. As the plaque grows, it begins to narrow the artery in which it is forming.
Overtime, this decreases the blood flow to the tissues distal of the plaque. If a plaque is formed
in another artery throughout the body, a portion of it could break off and travel to the cerebral
arteries, resulting in an embolic occlusive stroke (Shaffer & Bucher, 2017). Major Bay 4 has
numerous risk factors that could contribute to the development of atherosclerosis in his cerebral
tissue as will be discussed below.
3) Incorporate pertinent past medical history to EACH differential
Example: Smoking cigarettes is a significant factor in the development of atherosclerosis.
Nicotine in tobacco activates the release of epinephrine and norepinephrine, leading to an
increase in heart rate and blood pressure due to the vasoconstriction that occurs with nicotine.
Tobacco also causes an increase in LDL levels and release of toxic oxygen radicals. These two
factors add to the growing atherosclerotic plaque as continual damage is done to the endothelial
walls. Carbon dioxide may also irritate the lining of arteries and it decreases the amount of
oxygen that can be carried by hemoglobin, resulting in decreased blood oxygen levels (Shaffer &
Bucher, 2017). Major Bay 4 reported that he had been smoking for 25 years, making damage to
his epithelial lining a likely conclusion and increasing his risk for atherosclerotic build up in his
cerebral arteries. In addition, the patient’s venous CO2 level was 61.0 mmHg, which is
significantly higher than the normal range of 35-45 mmHg (Van leeuwen & Bladh, 2015).
Damage from smoking cigarettes is compound by further factors such as diabetes and
hypertension.
(You would then go on to explain the other factors such as diabetes and hypertension.)
4) Relate the patho/differential back to the patient, What did you see? How did the patient
appear? What where some pertinent exam findings to support this diagnosis or to rule against it?
Example: The patient did present as unresponsive in the field and became drowsy but responsive
to verbal stimuli with the administration of Narcan. In addition, the patient had pupils that were
equal, round, and reactive to light bilaterally. The patient was oriented to time, place, person, and
task. He had a strong grip bilaterally, showed no evidence of pronator drift, and was able to raise
each leg individually. His sensation was intact bilaterally and equally and he could perform facial
gymnastics as well as stick his tongue out. This neurologic examination reveals that Major Bay
4’s 12 cranial nerves are intact. It also appears as if all lobes of his brain are functioning properly
as he is continent, has no slurred speech, has no facial drooping, is able to think about questions
asked of him, passed his swallow screen, and remains balanced while standing when voiding.
Aside from being bedridden and tired, the patient shows no abnormal signs of weakness. Despite
the patient’s history of smoking, potential diabetes, and drug use, the patient’s neuro assessment
reveals normal function of brain activity. In addition, a head CT was not performed, so there is
no way to confirm if ischemia to the brain tissue occurred. A stroke is not the best conclusion to
the patient’s unresponsiveness and decreased breathing.
Care Plans:
ABC’s!!!!!!!!!!!!
Priorities please. This is the ED we care about what is MOST important and this will help you
learn to prioritize.
Example:
Drug Abuse: “actual” ineffective breathing pattern r/t vasoconstriction and inadequate oxygen
supply to the cerebral tissues AEB loss of consciousness, unresponsiveness, PaCO2 61 mmHg,
history of drug abuse, effective response of Narcan, respirations 10 bpm, nausea, vomiting, and
slight tachycardia
NOC
1. The patient will remain alert and oriented throughout the 8-hour shift while he is in the
ED AEB maintaining respirations above 12 bpm, be able to respond verbally to stimuli,
and having a heart rate below 100 bpm.
1a. During the 8-hour shift, the nurse will administer additional Narcan if the patient’s
respirations decrease below 12 bpm.
Rationale: Narcan is an opioid-antagonist that reverses the effects of opioid overdose,
including respiratory depression.
1b. During the 8-hour shift, the nurse will ask the patient questions that require a
response every 30 minutes to monitor how the Narcan is working throughout the patient’s
body.
Rationale: Asking the patient questions is a good way to monitor his level of
consciousness that should be improving as the drug overdose is reversed.
1c. During the 8-hour shift, the nurse will monitor all vital signs to ensure they remain
stable as the initial doses of Narcan wear off.
Rationale: As Narcan wears off, the patient may relapse into a state of opioid overdose
depending on the amount ingested. Monitoring vital signs ensures the nurse is aware if
there is a hemodynamic change in the patient’s status so proper intervention can occur.
Evaluation: During his stay in the ED, the patient remained oriented and fairly alert with
mild drowsiness AEB him sleeping frequently between nurse visits, answering questions
when asked, maintaining respirations between 16-20 bpm, and maintaining a heart rate
between 85-99 bpm. Evidence of relapse in respiratory depression would be seen with
decreased respirations, being unable to arouse, and heart rate greater than 100 bpm.
Powered by TCPDF (www.tcpdf.org)
