Cindy Black (fictitious name), a four-year-old child with wheezing, was brought into the emergency room by her mother for treatment at XYZ (fictitious name) hospital at 9:12 p.m. on Friday, May 13.
Initial triage assessment revealed that Cindy was suffering from a sore throat, wheezing bilaterally throughout all lung fields, seal-like cough, shortness of breath (SOB), bilateral ear pain. Vital signs on admission were pulse rate 160, respiratory rate 28, and a temperature of 101.6 °Fahrenheit (F) (rectal). Cindy Black was admitted to the emergency department for treatment. Notes written by the emergency department physician on initial examination read, "Croupy female; course breath sounds with wheezing; mild bilateral tympanic membrane hyperemia. Chest X-ray reveals bilateral infiltrates." Medication prescribed included Tylenol (acetaminophen) 325 mg orally for elevated temperature, Bronkephrine (ethylnorepinephrine hydrochloride) 0.1 millimeter subcutaneous, and monitor results.
Nurse Slighta Hand, RN (fictitious name) administered the medication as ordered and the child was observed for thirty minutes. Miss Hand's charting was brief, almost illegible, and read, "Medicines given as prescribed. Cindy observed without positive results. Physician notified."
The physician examined the child; notes read that the child had "minimal clearing" in response to the bronchodilator. The following medications were then prescribed: Elixir of turpenhydrate with codeine one milliliter by mouth, Gantrinsin (sulfisoxazole) 10
milliliters, and Quibron (theophylline-glycerol guaiacolate) 10 milliliters. Nurse Slighta Hand, RN charted the medications were given as prescribed. Her note at 11:08 p.m. read, "Vomiting; unable to retain medicine. Respiration increased (54), temperature 101.4°F (rectal); wheezing with increased difficulty breathing." No further notes were made regarding Cindy's condition on the emergency department record by the nurse, except to state that at 12:04 am, "child released from emergency department."
Thirty minutes after discharge from the emergency department, Cindy Black was brought back to the hospital. 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
· Failure of Miss Slighta Hand, RN to inform the physician that the patient did not improve after treatment
Analysis of the legal implications of the various nursing actions which would affect the outcome of a lawsuit includes monitoring the patient's condition and reporting changes therein to the physician, failure to communicate pertinent observations to the physician, and inadequate charting of important information. "Monitoring the patient's condition and reporting changes therein is one of the nurse's prime responsibilities. Nurses who fail to record their observations run the risk of being unable to convince a jury that such observations actually were made (Bernzweig, 1996, p. 171)." Nurses must constantly evaluate a wealth of information and results, and as soon as they become aware of any significant medical data, dangerous circumstances, or a...