It is 0800 hrs and you are a first year
nursing student working on theHuman Computer Interaction
medical ward of a regional hospital.
Mrs Fiona Watkins
70 years, has been
admitted to the
ward.
She appears
dishevelled and
quite anxious; she
is wearing a
hospital gown.
Fiona’s story
Fiona married the first man that showed her any real interest and she and Keith moved into a flat that he already owned and Fiona was soon
pregnant. After a few years, with three children under five and now pregnant again, Keith informed Fiona that she was burden, selfish and
ungrateful. That all she did was spend his hard earned money. Desperate to please Keith, Fiona began working casually cleaning offices at night.
She cared for the children and the house during the day and then, once her husband arrived at home, she went out to work. Throughout these
years, Keith continued the narrative “You are so selfish and useless”. Her children heard this narrative and eventually, they started chorusing what
their father was saying “Selfish, bore, useless, bad wife, bad mother”.
When Keith died (2015), he was honoured by his family and friends as being a hard worker and a loving father. Fiona’s hands shook too much to
clean anymore. Fiona shook whenever she looked in the mirror. She was very afraid.
The estate went to the children. “It’s what dad wanted. It’s what we deserve.” Fiona had no financial security. The children sold the home from
underneath her and then shipped her back and forth between them. They were too busy to take her to the doctor, so she didn’t go. They were too
inconvenienced by her presence to invite her to family events, so she didn’t go. They told her it would be better for her if she found a place of her
own and started to pull her own weight. “You can’t keep living off other people, Mum!” Fiona made rent on her flat for a while, but after she was
hospitalised in 2017 she was evicted. When Fiona first went to a women’s shelter and they asked her if she had any family nearby she said no.
The senior nurse provides the following handover
| I: S: |
This is Mrs Fiona Watkins, MRN 180131, DOB: 01.01.1950 Mrs Watkins is a new patient admitted this morning via the ED with suspected pneumonia. Mrs Watkins presented to ED after being referred by a local GP. Mrs Watkins has a history of flu like symptoms (coughing, headache, nasal mucous production, pyrexia, and fatigue) for the past week that has |
| B: |
progressively worsened. She has a history of childhood asthma,
polypharmacy overdose and sacrum pressure injury (2017). She takes
no regular medications.
| A: | On arrival to ED vital signs were: RR 18 breath/min, SpO2 97% RA, HR 95 bpm, BP 135/80mmHg, T 37° Celsius Could you please complete an A – G (+H) assessment as the Medical team will be here soon to review. |
| R: |
Consider the patient situation
You perform an A-G (+H) assessment
| A: B: |
Airway is patent-nil signs of airway obstruction, speech is normal RR 26/min, SpO2 94% RA, increased work of breathing and accessory muscle use, productive mucosal cough HR 110 bpm, BP 130/80mmHg cap refill < 2secs, warm to touch Alert, feeling anxious, able to move all limbs T 38.8° Celsius, dry, flaky and fragile skin, bruising noted on right elbow, small lesion right arm (redressed in ED, dressing intact) healed wound on sacrum. BNO today. Malnourished and deconditioned in appearance. PIVC x 1 L hand, voided x 1 since arrival (350mls), tolerating oral fluids BGL 5.5mmol/L Feeling anxious and scared, no current NOK, No secure address and worried about belongings |
| C: D: E: |
|
| F: G: H: |
When you about to leave Mrs Watkins tells you that she “does not want to be in
hospital” and asks you “when can I go home?”
Collecting cues/information