Introduction

Some patients you will care for during your clinical placement will have been admitted to hospital via the emergency services, usually through the accident and emergency (A&E) department or similar named units. This can be a traumatic experience not only for the patient but also for their families, carers, friends and sometimes even the nursing staff working in the department. This chapter focuses on a patient journey from the A&E department to the orthopaedic ward where you are undertaking your clinical placement experience.

Introduction to patient and clinical problem

Mrs Elsie Waters is an 80-year-old woman who lives on her own in a small bungalow that has been adapted to her needs. Her son and his family live close by and he or his wife call every day to see if she needs anything. He has also ensured she has a mobile phone in case she requires help and she uses it to call with any shopping or other needs.

On this particular day, her son let himself into the house, calling to his mother that he had arrived and asking where she was. Not getting any reply, he became worried and started to search the bungalow. He heard a weak call for help and found his mother on the floor of the bedroom with the mobile phone some distance away. It was clear she had fallen for some reason and articles from the bedside table were all over the floor. She was weak but was able to tell her son that her right hip hurt and she was unable to move that leg.

He immediately called an ambulance and placed a pillow underneath his mother’s head but did not move her until they arrived. Within 10 minutes, the paramedic team arrived, assessed the situation and made a provisional diagnosis of a fractured neck of femur. They ensured a safe transfer from the floor onto a stretcher and informed her and her son that they would be taking her to the hospital. Her son told them he would sort out some clothes and other things for her, as it was clear she would be required to stay in hospital, and that he would follow them. He phoned his wife at work to let her know about his mother and that he would be going to the hospital with his mother and that he would phone back once she had been seen by the doctor in the A&E department.

Falls in the elderly population

Being mobile is very important to an older person like Mrs Waters and, like her, many live independent lives. However, Hindle (2011) states that, according to Help the Aged data, falls in the elderly ‘represent over half of hospital admissions for accidental injury – particularly hip fracture’ (Help the Aged 2005).

Admission to hospital

When Mrs Waters arrives at the A&E department, she is experiencing a great deal of pain in her right hip and side, she has a cut on her head (which is thought to have happened when she fell and hit her head on the corner of her bedside table), her pulse rate is raised and she is very pale. She is also worried about her cat and who is going to look after him. Her son arrives and reassures her about this latter concern.

Immediate care in the A&E department

The Scottish Intercollegiate Guidelines Network (SIGN) guidance (SIGN 2002) would be used to guide the perioperative period of care for Mrs Waters, including the immediate management in the A&E department. The guidelines (section 4) recommend early assessment and recording of the following, either in A&E or if admitted first prior to surgery on the ward (SIGN 2002):

They also suggest there should be immediate steps taken to prevent the development of pressure sores and that those at high risk of developing pressure sores should be assessed using appropriate assessment tools. They recommend that any patient admitted to A&E with a suspected hip fracture should also be managed as detailed in Box 13.1.

The triage nurse assesses Mrs Waters as someone who requires to be seen immediately by the doctor and who requires pain relief and an X-ray in order to make a diagnosis and also to make her more comfortable. Pain relief is ordered by the doctor and given by the staff nurse looking after Mrs Waters, prior to her being moved from the trolley to the X-ray table. The nurse accompanies her to the radiography unit which is next to the A&E department so that patients can easily be transported and returned.

Stay updated, free articles. Join our Telegram channel

Join