Case Study #4 (Application of Patient Safety Goals) Watch the Lewis Blackman Story Video #1. Answer the following questions. Why does Helen Haskell start her story by talking about Lewis? It is a way to capture the attention of her audience & be able to empathize with her story What is Ketorolac (indications, side effects, normal IV dosages for 15-year-old, risks & benefits)? Ketorolac (Toradol) is a nonsteroidal anti inflammatory agent (NSAID) & nonopioid analgesics. It is for short-term management of pain & not to exceed 5 days total of use for all routes. Side effects include hyperkalemia, oliguria, renal toxicity, increased liver enzymes, diarrhea, GI pain, drowsiness, edema, vasodilation. Life threatening adverse effects are HF, MI, stroke, exfoliative dermatitis, Steven-Johnson syndrome, GI bleed. IV dose range for children 2-16 y/o is 0.4-1 mg/kg as a single dose w/ a maximum of 15 mg/dose; multiple dosing is 0.5 mg/kg q 6 hr. Serious risks associated with this drug is risk of GI ulceration, bleeding & perforation as relevant to this case study. Benefit of this drug is that it is a non addictive pain medication & is effective for managing acute pain What was the significance of lack of urine output (to underlying problem, amount of Ketorolac, & need for fluids)? Lack of urine places pt at risk for renal failure due to volume depletion. Ketorolac is metabolized mainly in the liver but is excreted by the kidneys. Because this drug can cause oliguria, hyperkalemia & renal toxicity, it is imperative to have sufficient fluid resuscitation to compensate for fluid depletion What are possible reasons why health care providers dismissed implications of undetectable blood pressure? Why would they think it was equipment failure? I have no explanation for this. In all my 11+ years in healthcare, I have learned that suspicious blood pressures or machine errors should be rechecked & validated by manually checking blood pressure by using sphygmomanometer. This should be a standard protocol by the facility.
Do you agree that it was significant that Lewis’s crises developed on the weekend? Explain why or why not. No. Because even on weekends, there are on-call doctors & emergency procedures that can be done on weekends. Healthcare, in general, is 24/7. There are nurses, doctors, rapid response team, house supervisors, nursing managers, & other disciplines that should have been consulted. This did not just happen over a weekend, there were precipitating factors that lead to this event that may have either been neglected or missed. Lewis died from septic shock. Describe the incidence, signs/symptoms, & appropriate interventions for this problem. Septic shock arises from SIRS then sepsis that is not treated or not managed. Septic shock leads to multiple organ dysfunction due to abnormal response to infection accompanied by circulatory & metabolic abnormalities.
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- Fall '19
- Pediatrics, Health care provider, Helen Haskell