Malpractice Case: Alterations In The Emergency Department

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Register to read the introduction… This time her vital signs were absent, her skin was warm without mottling, and the pupils of the eye were dilated but reacted slowly to light. Cardiopulmonary resuscitation was instituted without success, and Cindy Black was pronounced dead. Departure from professional standards of nursing care:
In every nursing malpractice case the defendant nurse's conduct is measured against that of a reasonably prudent nurse under the same or similar circumstances. Departure from the professional standards of nursing care for the first admission to the emergency department included the following deviations: · Failure to assess Cindy Black comprehensively upon discharge

· Failure to assess the patient systematically for the duration of the emergency department
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Their failure to communicate these observations can have disastrous consequences and will certainly increase the chances for malpractice litigation (Bernzweig, 1996, p.

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Alterations in the nurse's behavior:
Children with respiratory problems need skilled and competent nursing care.
The symptoms of hypoxemia, a complication of respiratory problems, are often insidious. Frequently, there is peripheral vasoconstriction with accompanying skin color changes. Tachypnea, tachycardia, anxiety, and confusion may ensue.
It is the nurse's responsibility to observe, evaluate, and document the patient's condition. In the emergency department, the nurse is the member of the health-care team who has the greatest contact with the patient. Any significant change in the patient's condition, based upon nursing observation, must be promptly communicated to the physician.
The nurse should have informed the physician promptly of the 11:08 p.m. observations. These indicated that the child's condition was not improving but was, in fact, deteriorating. Before processing the discharge order, the nurse should have communicated to the physician that the child had failed to
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Nursing malpractice can be minimized if the nurse utilizes the nursing process and delivers patient care that conforms to the

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prevailing professional standards. Fundamental to the nursing process is a complete initial nursing assessment and history, followed by continuous systematic patient assessment.
The initial nursing assessment in the record was incomplete. This assessment of the child should have included such information as follows:

· General appearance: height and weight in relation to age, development of the body, color of the skin, posture, facial expression, presence of fatigue or hyperactivity, gait, an presence/absence of apprehension

· Neurological status: level of consciousness, signs of menigeal irritation

· Vital signs: temperature, respiration (rate, rhythm, character), pulse
(rate, rhythm, quality), and blood pressure.

· Skin: color, temperature, presence/absence of eruptions, cyanosis, erythema, icterus, petechiae, cysts, trauma, and scars

· Developmental status

· Disease status: breath sounds, presence/absence of congestion

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