PNA100N1M - Clinical Scenario Assignment (50 marks total = 10% of Final Grade) PART A — The Emergency Department (ED) at your hospital has been advised that a female patient is on route by ambulance with an occupational injury

PNA100N1M - Clinical Scenario Assignment

(50 marks total = 10% of Final Grade)

PART A — The Emergency Department (ED) at your hospital has been advised that a female patient is on route by ambulance with an occupational injury. As the RPN on duty, she is brought to your assigned bed space, accompanied by her male partner and her twin sister. The decision was made to transport her by ambulance when she complained of feeling faint and was unable to stand. Upon her arrival, you notice the towel wrapping her forearm is fully soaked with blood and you collect the following additional details for your chart:

Your patient is a 40-year-old female chef who reports working long hours at her family-owned restaurant. She sustained an injury to her left forearm after a serious fall in the restaurant kitchen approximately 3 hours ago. After physical examination and additional health history, the following details were added to her chart:

• Pallor
• 3cm bone fragment protruding from distal lateral forearm
• Significant blood loss at site of injury
• Heart Rate 125 bpm (elevated)
• Blood pressure 90/55 (low)
• Respiration 25 breaths/minute (elevated)
• O₂ saturation 99%
• Pain 10/10
• Patient complaining of “dizziness” and “nausea”
• Patient is 20 weeks pregnant (G1P0) — first pregnancy
• Maternal vitamins (q. d.)
• No history of prescription medications
• No current medications

A blood sample is drawn and sent to the hematology lab for testing. The following additional details are noted for this patient:

• AB-negative

Low hematocrit and hemoglobin  Anemia

1. Using your understanding of anatomy and physiology describe the ways in which you believe various processes of homeostasis have been disrupted and the process or treatment that would help to restore homeostasis in each case. Please explain your reasoning (answer the ‘why’) and references to support your answers (10 marks)

2. What forearm structures are likely to have been injured? Discuss why is this is important to her entire clinical picture. Are there any additional questions about the timing or severity of her symptoms that you might ask regarding this injury? Please explain your reasoning (answer the ‘why’) and references to support your answers. (10 marks)

3. If each of her signs and symptoms represent some deviation from homeostasis, in which order would you address her symptoms (ie. which symptoms are the most concerning from a physiological perspective) and why? Please explain your reasoning (answer the ‘why’) and references to support your answers. (10 marks)

PART B -— Since the patient’s blood tests also reveal that the patient’s hemoglobin is critically low, it is decided that she will require a blood transfusion before proceeding with any surgical treatment. At this time, the following additional information is gathered:

• Husband's blood type is O-positive
• Sister’s blood type is B-negative

4. Explain whether each of the following treatment option(s) is/are possible and discuss why or why not. Please explain your reasoning and provide references accordingly (10 marks)

• Receive a blood transfusion from a universal donor
• Receive a blood transfusion from her husband
• Receive a blood transfusion from her sister

5. The medical team decides to give the patient intravenous isotonic fluids to restore blood volume and performs a transfusion using only packed red blood cells from an O-negative donor. Discuss why they would have chosen this treatment using your knowledge of the blood types that were discussed in class. Please provide references accordingly (10 marks)