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Nov 24, 2024

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1 First Line Intervention Student Name Institution Course Professor’s Name Date First Line Intervention Question 1 Michael is exhibiting signs and symptoms of deterioration, suggesting a potential systemic infection and sepsis. Initially presenting with a sore foot and pain, his condition has worsened over time. Signs of deterioration include an increase in heart rate from 110 to 130 bpm, a rise in respiratory rate from 20 to 22 bpm, a temperature increase from 37.8 to 38.8 degrees Celsius, and a drop in blood pressure from 160/80 to 165/70 mmHg. These vital sign changes indicate a progression of systemic distress. Michael's increased lethargy, persistent nausea, and heightened pain in the foot (5/10 to 6/10) further emphasize the deterioration. The swelling, warmth, blistering, and dirty wound with exudate of pus and haemoserous fluid on the affected leg are indicative of an infected wound. The deterioration is evident as the wound progresses from an initial presentation to a more severe state. Additionally, the hypotension, tachycardia, and increased temperature signify a systemic response to infection ( Evans, 2018) . As the patient becomes more lethargic, his overall clinical condition declines ( Gyawali et al., 2019 ). These signs collectively suggest systemic inflammatory response syndrome (SIRS) and sepsis, necessitating immediate intervention ( Kaukonen et al., 2015 ). In my previous experiences, I have encountered patients with deteriorating conditions, and the recognition of vital sign changes and clinical deterioration is crucial for timely intervention and optimal patient outcomes. Question 2 The potential cause of Michael's deterioration could be septicemia, also known as sepsis, which is a severe and life-threatening response to an infection in the bloodstream. The pathophysiology of septicemia involves a complex cascade of events that can lead to organ dysfunction and failure if not promptly treated. When an infection enters the body, it triggers an immune response. In septicemia, the infection spreads to the bloodstream, causing a systemic inflammatory response. This leads to the release of pro-inflammatory cytokines such as interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-alpha), and interleukin-6 (IL-6) ( Werners, 2017) . These cytokines promote inflammation and cause vasodilation, increased vascular permeability, and activation of blood clotting mechanisms.

2 As a result of vasodilation and increased vascular permeability, blood vessels become leaky, leading to fluid and proteins leaking out of the blood vessels and into the surrounding tissues ( Berg & Gerlach, 2018 ). This can cause a drop in blood pressure and inadequate perfusion to vital organs, leading to organ dysfunction. In Michael's case, the hypotension and tachycardia observed could be a result of reduced blood flow and compensatory mechanisms to maintain cardiac output. The release of pro-inflammatory cytokines also activates blood clotting mechanisms, leading to the formation of microclots throughout the body. These microclots can impair blood flow and contribute to further organ dysfunction ( Taeb et al., 2017 ). Additionally, the systemic inflammation can lead to increased capillary permeability and tissue edema, which may explain the swelling and blistering observed on Michael's affected leg. Furthermore, septicemia can lead to dysfunction of the coagulation system, resulting in a decreased platelet count and impaired clotting ( Cinel & Dellinger, 2007) . This can manifest as bleeding tendencies or abnormal clotting, which may explain the oozing from Michael's foot wound. Therefore, the pathophysiology of septicemia involves a dysregulated immune response to an infection, leading to systemic inflammation, vasodilation, increased vascular permeability, activation of blood clotting mechanisms, and organ dysfunction. Prompt recognition and treatment and supportive care are crucial to improve outcomes and prevent further deterioration in septicemia. Question 3 In this situation, my immediate nursing responsibilities would be to assess and prioritize Michael’s condition, provide appropriate interventions, and ensure his safety before the retrieval service arrives. Firstly, I would assess Michael’s airway, breathing, and circulation (ABCs) to ensure they are intact and stable. This includes checking for any signs of respiratory distress, ensuring he has a patent airway, and monitoring his blood pressure, heart rate, and oxygen saturation levels. The reason for this priority is to ensure that his vital functions are maintained and any immediate threats to his life are addressed. With the presence of a substantial open wound and signs of infection, I would also prioritize wound care and infection control. This would involve cleaning the wound, applying appropriate dressings, and administering antibiotics as prescribed. The goal is to prevent the spread of infection and promote wound healing. Additionally, I would monitor the wound for any signs of worsening infection such as increased redness, swelling, or discharge. Another important responsibility would be to manage Michael’s pain and provide comfort measures. I have already administered Paracetamol for pain relief, but I would reassess his pain level and administer additional analgesia if necessary. Pain management is crucial not only to alleviate discomfort but also to facilitate rest and recovery. Given Michael’s deteriorating condition with increasing temperature, hypotension, and tachycardia, I would closely monitor his vital signs and notify the ED consultant of any significant changes. This is important as these vital signs may indicate sepsis or systemic infection, which requires immediate

3 medical attention. Furthermore, I would implement cooling measures such as applying cool packs or damp towels to help reduce his body temperature. While waiting for the retrieval service, I would ensure Michael’s comfort and provide emotional support to him and his partner. This includes explaining the current situation, reassuring them that help is on the way, and addressing any concerns or questions they may have. Maintaining open communication and a calm demeanor can help alleviate anxiety and build trust. Lastly, I would coordinate with the clinical nurse and update them on the situation, ensuring that they are informed and able to provide continuity of care once they arrive. It is essential to have a cohesive and collaborative team approach in managing emergency situations. In reflecting on past experiences, I have encountered similar emergency situations where immediate action was required. Through these experiences, I have learned the importance of effective and efficient assessment, prioritization, and communication. In such situations, it is crucial to remain focused, calm, and confident, relying on evidence-based practices and established protocols. Additionally, utilizing resources such as clinical guidelines, research articles, and peer-reviewed literature can further enhance decision-making and outcomes. These experiences have reaffirmed the significance of continual learning and staying updated with current best practices in emergency nursing. Question 4 In the challenging scenario presented, effective communication is crucial to ensure the best possible care for Michael and coordination with various stakeholders. Firstly, when communicating with Michael, employing culturally sensitive and respectful communication is essential. Understanding his cultural background and preferences will foster trust and cooperation. Utilizing plain language to explain his condition, treatment plan, and the importance of evacuation is vital, considering potential impacts of alcohol on comprehension. For Michael's family, particularly his partner, clear and empathetic communication is necessary. Updating them on Michael's condition, the urgency of the situation, and the planned interventions will help alleviate anxiety and facilitate their understanding. When liaising with the medical officer, conveying concise and accurate information regarding Michael's deteriorating condition, vital signs, and the interventions initiated is imperative. Maintaining open lines of communication with the retrieval team is essential for a smooth transition of care during evacuation. Effective communication with the wider community involves disseminating information about the situation without breaching confidentiality, ensuring transparency, and addressing any concerns or rumors that may arise ( Maiorano et al., 2020 ). Question 5 Caring for Michael, whose wife is employed at the center and with whom I have developed a friendship, presents unique challenges. The dual relationship introduces emotional complexities that may impact the provision of unbiased and equitable care. The pre-existing connection with Michael's partner could potentially influence my decision-making and communication. Striking a balance between maintaining

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4 professional boundaries and demonstrating empathy is crucial. The challenge lies in ensuring that personal relationships do not compromise the prioritization of patient welfare. Moreover, the familiarity with Michael's partner may also affect her emotional state and ability to comprehend the severity of the situation objectively. Communicating the gravity of Michael's deteriorating condition and the need for urgent transfer to Cairns Hospital becomes delicate, as it involves not only professional responsibilities but also considerations for the emotional well-being of someone I have a personal relationship with. Question 6 During the emergency situation with Michael, there are several strategies that I would implement to maintain both professional and personal safety. Firstly, ensuring my own personal safety is vital. This includes following proper infection control protocols, such as wearing appropriate personal protective equipment (PPE) like gloves and a surgical mask when cleaning the wound and administering medication. It is also important to maintain a safe distance from the patient, especially if they are exhibiting signs of aggression or intoxication. In terms of professional safety, I would ensure that I am following proper clinical guidelines and protocols when assessing and treating Michael. This includes correctly administering medications, monitoring vital signs regularly, and documenting all interventions and observations accurately. I would also communicate effectively with the ED consultant and retrieval service to provide updates on Michael's condition and ensure appropriate support and resources are being arranged. Post emergency, I would find it crucial to debrief and reflect on the situation, processing any emotional or psychological impact it may have had on me. Seeking support from my colleagues or supervisor is helpful in dealing with any stress or trauma I may have experienced. To ensure my personal safety, I establish boundaries with patients and their families, especially in situations where personal relationships may exist. It's essential to maintain a professional approach and prioritize the patient's well-being over personal connections or biases. In general, maintaining my professional and personal safety requires adherence to best practice guidelines, effective communication, and implementing self-care strategies to manage the emotional and physical demands of emergency situations. Post During my placement in the Golden Plains Medical Centre regional Victoria, I did research in the community before starting my placement. I learned thatGolden Plains Medical Centre is an isolated area with a population consisting of both Indigenous and non-Indigenous clients. The center provides multiple services to the community, but there is no medical doctor available on-site. Instead, there are visiting medical services. This means that access to medical care is limited and often relies on external resources.

5 Comparing the options and outcomes for Michael in Golden Plains Medical Centre to those in a capital city, it is clear that the resources and healthcare facilities are significantly different. In a capital city, there would likely be a medical doctor available on-site, immediate access to advanced medical equipment, and a faster response time for emergency services. In Golden Plains Medical Centre, the options are limited and rely on the visiting medical services. This can result in delays in receiving appropriate care, especially in emergency situations. Through my experiences, my view of the role of the registered nurse working in an isolated practice has changed. I have come to appreciate the challenges and responsibilities that come with being the primary healthcare provider in an isolated area. In such settings, the registered nurse often has to make critical decisions and manage emergencies with limited resources and support. The role requires strong clinical skills, critical thinking, and the ability to work autonomously. Emergency care in an isolated practice area is managed with the available resources and support. In this case study, the registered nurse contacted the Cairns Hospital for advice and received necessary prescriptions for medications. However, the availability of advanced medical interventions and immediate access to specialty care is limited. The reliance on retrieval services and the need to transfer the patient to a larger healthcare facility demonstrates the challenges in managing emergency situations in isolated areas. During my time in the rural/isolated practice area, I felt accepted as a valued member of the medical team. Communication with the clinical nurse and the ED consultant was crucial in managing the emergency situation. Despite the physical distance, there was effective communication via phone and fax. The team worked collaboratively to provide the necessary support and guidance. However, I also recognized the importance of building relationships and trust with the community members to ensure effective healthcare delivery in an isolated setting. In conclusion, my experiences in an isolated practice area have given me a deeper understanding of the challenges and responsibilities of a registered nurse in such settings. The limited access to resources and the need for effective communication and collaboration highlight the importance of adaptability and critical thinking in delivering quality care to patients in emergency situations. References Werners, A. H. (2017). Treatment of endotoxemia and septicaemia in the equine patient. Journal of Veterinary Pharmacology and Therapeutics , 40 (1), 1-15. Gyawali, B., Ramakrishna, K., & Dhamoon, A. S. (2019). Sepsis: The evolution in definition, pathophysiology, and management. SAGE open medicine , 7 , 2050312119835043. https://doi.org/10.1177/2050312119835043 Evans, T. (2018). Diagnosis and management of sepsis. Clinical Medicine , 18 (2), 146. Taeb, A. M., Hooper, M. H., & Marik, P. E. (2017). Sepsis: current definition, pathophysiology, diagnosis, and management. Nutrition in Clinical Practice , 32 (3), 296-308.

6 https://doi.org/10.1177/0884533617695243 Cinel, I., & Dellinger, R. P. (2007). Advances in pathogenesis and management of sepsis. Current opinion in infectious diseases , 20 (4), 345-352. Maiorano, T., Vagni, M., Giostra, V., & Pajardi, D. (2020). COVID-19: Risk factors and protective role of resilience and coping strategies for emergency stress and secondary trauma in medical staff and emergency workers—An online-based inquiry. Sustainability , 12 (21), 9004. Berg, D., & Gerlach, H. (2018). Recent advances in understanding and managing sepsis. F1000Research , 7 . Kaukonen, K. M., Bailey, M., Pilcher, D., Cooper, D. J., & Bellomo, R. (2015). Systemic inflammatory response syndrome criteria in defining severe sepsis. New England Journal of Medicine , 372 (17), 1629-1638.

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