A nurse is contacting the on-call healthcare provider about a patient who underwent a hysterectomy two days ago and is experiencing pain that is not alleviated by the prescribed opioid pain medication. Which statement constitutes the “Background” portion of the SBAR format for communication?
“I would like you to prescribe a different pain medication.”
“This patient underwent a vaginal hysterectomy two days ago.”
“The patient, D.A. Smith, has an aversion to nonsteroidal anti-inflammatory medications.”
“This patient has allergies to morphine and codeine.”
The Correct Answer is B
Choice A rationale:
This statement belongs to the "Request" portion of the SBAR format. It articulates a specific action the nurse wants the healthcare provider to take.
It's not part of the Background because it doesn't provide any historical or contextual information about the patient's condition.
Choice B rationale:
This statement is the correct choice for the "Background" portion of the SBAR format.
It provides essential background information about the patient's recent medical history, specifically the recent hysterectomy.
This information is crucial for the healthcare provider to understand the context of the current situation and make informed decisions about pain management.
Choice C rationale:
This statement provides additional patient information, but it's not the most relevant for the Background section in this context.
The patient's aversion to NSAIDs might be important for medication choices, but it doesn't directly address the current issue of pain management after a hysterectomy.
Choice D rationale:
This statement provides important information about the patient's allergies, but it's not the most relevant for the Background section in this context.
Allergies are crucial for medication safety, but they don't directly address the current issue of pain management or provide context about the patient's recent surgery.
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Correct Answer is C
Explanation
Choice A rationale:
While providing information about post-operative care and pain management is important, it may not directly address the patient's underlying anxiety or encourage them to express their concerns.
It could be perceived as dismissive of their feelings or as an attempt to control the conversation. It focuses on the future rather than the patient's present experience.
Choice B rationale:
This response, while intended to be reassuring, may minimize the patient's individual experience and feelings. It could make the patient feel as though their concerns are not being taken seriously.
It implies that anxiety is a normal and expected reaction, which may discourage the patient from sharing their specific worries.
Choice C rationale:
This response is open-ended and invites the patient to share their thoughts and feelings.
It demonstrates active listening and encourages the patient to take an active role in the conversation.
It allows the nurse to assess the patient's understanding of the surgery and to address any misconceptions or concerns. It conveys a sense of empathy and understanding, which can help to build trust and rapport with the patient.
Choice D rationale:
While offering to explain the procedure may be helpful, it may not be what the patient needs at the moment. It could overwhelm the patient with information, particularly if they are already feeling anxious.
It could shift the focus away from the patient's emotional needs and onto the technical aspects of the surgery.
Correct Answer is D
Explanation
Choice A rationale:
Incorrect. Deep-breathing exercises could potentially worsen stridor. Stridor is a high-pitched, wheezing sound caused by a partial obstruction of the upper airway. Deep breathing can increase airflow through the narrowed airway, making the stridor more pronounced and potentially worsening the obstruction. In severe cases, it could lead to complete airway obstruction and respiratory distress.
Risk of aggravation: Deep-breathing exercises could aggravate the underlying cause of stridor, such as laryngeal edema or vocal cord dysfunction, by increasing inflammation or muscle tension in the airway.
Delay in definitive treatment: Focusing on deep-breathing exercises might delay more definitive interventions, such as intubation, which might be necessary to secure the airway and prevent respiratory failure.
Choice B rationale:
Incorrect. While albuterol nebulizer therapy can be helpful for bronchospasm, it is not the first-line treatment for stridor. Stridor is typically caused by an upper airway obstruction, and albuterol primarily targets the lower airways (bronchioles).
Limited effectiveness: Albuterol might not be effective in reducing stridor caused by upper airway obstruction, as it does not directly address the narrowing of the airway.
Potential for adverse effects: Albuterol can cause tachycardia, tremors, and anxiety, which could further complicate the patient's condition.
Choice C rationale:
Not the most immediate action. While calling a Rapid Response might be necessary if the patient's condition deteriorates, the first priority is to secure the airway and ensure adequate ventilation.
Time-consuming: Activating a Rapid Response team can take several minutes, and the patient's condition might not allow for that delay.
Choice D rationale:
Prioritizes airway management: Intubation is the most effective way to secure the airway and ensure adequate ventilation in a patient with stridor. It bypasses the obstruction and allows for controlled delivery of oxygen and ventilation.
Addresses potential for deterioration: Stridor can rapidly progress to complete airway obstruction, so prompt preparation for intubation is crucial to prevent respiratory failure.
Involves the primary healthcare provider: Consulting the primary health care provider ensures timely decision-making, appropriate medication administration (such as sedatives or paralytics for intubation), and coordination of care.
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