Nursing Assessment

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Physician Dismisses Nursing Assessments, Question of Nurse Advocacy.

Summary: The patient was involved in a motorcycle accident in which his bike fell onto and injured his left leg. When the nurses assessing the patient could not detect a pulse in that leg, an ominous sign of circulatory failure. The physician when notified chose to dismiss this fact and discharge the patient. The patient would return soon after with worsening symptoms that would require emergency surgery. Should the nurses have initially pressed for further action, treatment?

The patient was involved in a single vehicle accident involving his motorcycle and brought to the Emergency Department for left leg injuries, specifically a knee injury. While riding he had lost control and when he fell was pinned under his bike.

“Single vehicle motorcycle crashes account for about 45 percent of all motorcyclist fatalities. More than 38,000 motorcyclists have died in single vehicle motorcycle crashes between 1975 and 1999. The report claims to provide data for insight into possible causes for these fatalities. According to the report, from 1990 through 1999, there were a total of 11,038 fatal single vehicle motorcycle crashes. During that same time period, there were an estimated 294,000 non-fatal single vehicle motorcycle crashes.”2

In the course of a detailed assessment and evaluation by the Nursing staff, it was noted that the patient had no detectable pulse in the left leg or foot. The patient was also complaining of severe pain and numbness in that leg.

In some patients a pulse may be difficult to palpate, or not detectable at all by touch under normal circumstances. In those patients a “Doppler Ultrasound” can be performed which is more sensitive for detecting pulses not detectable otherwise. Though performed several times in different areas, even with the Doppler, no pulse was detected by the nurses.

“There are many ways to test blood flow to the lower legs. In Doppler testing, an...
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