CASE SCENARIO: MULTIPLY RISK FRACTURE.

A 54Years old man with multiple rib fracture left chest tube in place.Weighs 195lbs and 5feet 9inches tall,patient is alert and oriented x 3 with lots of pain.Chest tube to suction with serosanganous drainage,hit by oncoming car speeding at 40mls per hour.History of depression ,told friends and family members that he is tired of existing and will love to join his ancestors.( When asked, patient replied and said ,I guess God is too busy and not ready to receive me.I am just tired of losing jobs,begging everyone to help me)Pneumothorax hence the chest tube placement.Clavicle fracture,elbow dislocation.ORIF of left elbow, left rib fractures 3 to 10,and humerus fracture.02 at 3liter nasal canula.Left rib platting,vats left thoracotomy and elbow surgery done.Wound to the coccyx area while in ICU.

PT/ST/OT consult done ,physical therapy ,speech therapist and occupational therapy are all working on the patient.DVT left lower extremity,okay to use SCD on bilateral lower extremity.Standard precautions.Risk for falls ,so patient is on fall precautions.Transportation method bed.Skin intergrity impaired. Encourage reposition. Nonweight bearing to bilateral upper extremity.All consultations done.DME ordered and delivery pending at this time.NKDA,Regular diet,he eats very slowly.Family at his bedside 24/7. Medications: Dilaudid 2mg iv Q3hours prn severe pain ,Norco 10/325mg 2tablets po Q6hours prn moderate pain.Gabenpentin 900mg po Qdaily. Seroquel 150mg po bid.Heparin 5000unit subQ TID.

Medication reconciliation done.

Saline left to right upper arm 20guage C/D/I.

Chest/Arm brace in place.

Laboratory test: Hgb 9.0,Hct 28.9,magnesium 1.6 replaced with 2grams of magnesium.

K level 4.0,NA =139.Voiding well using the urinal at the bedside.Dressing change done by woundcare nurse.English speaking patient interpreter not needed.So he is placed in room without the blue phone ,just the reg white standard hospitals phone .On suicidal watch while he was in ICU. MD made aware.Psychiatric consult completed.5150 that is 72hour hold was completed in ICU.

Discharge Plans.Patient will be transfered to Skilled Nursing facility.Accepting doctor on board instructed that the skilled nursing facility Registered nurse should call him for clarification of orders and other questions as soon as they receive the patient.

Questions .

1.How will you help this patient as a nurse?.

2. Why did he want to take his own life?.

3.Should this patient be placed on suicidal watch?.