case study

case study

You are a new graduate nurse working in a general surgical ward on an evening shift. It is 16oohrs and you receive a new admission from the Emergency Department. Ms. Vera Wong is a 24 year old female who has been admitted with a 12 hour history oflower abdominal pain, increasing in intensit over the last 4 hours in the right lliac fossa (RIF). She has no relevant medical history although she is obese weighing 145kg and is 168cm tall.

She was reviewed by the surgical team in the Emergency Department and a provisional diagnosis of
acute appendicitis was given. She is also to be reviewed by the surgical registrar on the ward later in

the evening for possible surgery if her symptoms persist. Ms. Wong is currently Nil by Mouth and has

a McGill pain score of7/10. You review her medication chart and note the following PRN medications:
Morphine 1oomg lMl q4h, Metoclopramide 1omg lMl q8h and Paracetamol 1gm PO q6h.

You introduce yourself to Ms. Wong and she informs you that she is in significant pain and requests

pain relief. You inform Ms. Wong that you will administer a Morphine injection for her pain.

You ask a fellow Registered Nurse to check out the Morphine which is supplied in the following ampoule
strengths: 1omg/1ml and 3omg/1ml.

You check out 3x 3omg ampoules and 1x 1omg ampoule whilst

correctly completing the S8 register. You prepare the injection using a sterile

technique along with

Metoclopramide1omg. You administerthe medication lMl to Ms. Wong.

It is now 18oohrs and you are undertaking your

medication and observation round, when you get to

Ms. Wong, you find herto be unrousable with a respiratory rate of6. You immediately

activate the

Rapid Response Team. When the Team arrives they undertake a primary survey and assess the
patient notes. You inform them of

the medication you have administered. The team administers

Naloxone Hydrochloride 12ooug l/. Ms. Wong’s level of consciousness and

respiratory rate improve.

The surgical registrar attends the MET call also and states he accidentally wrote 1oomg instead of
1omg forthe

morphine dose.

Case Study Questions

01. This case study illustrates a medication errorwhere the wrong dose was prescribed and
administered. In 500 words, state howthis adverse event could have been prevented. You should
systematically work through the six rights

and discuss what strategies you would employ to

ensure you administerthe right dose.

02. In 250 words, identify and discuss the relevant

Australian Nursing and Midwifery Accreditation

Council (ANMC) competency standards that are breached in this case.

03. As a Registered

Nurse, priorto administering any medication, what key information related to the

pharmacology ofthe medication should you have a

comprehensive knowledge of? (250 words)

04. The following morning you are on a day shift, the Nurse Unit Manager asks you into the office.
She informs you that the adverse drug administration has been logged on the hospital incident
management system (IMS) and that you are

required to write a report and also be interviewed by

the RCA (Route Cause Analysis) team. You are feeling very apprehensive about writing


report and meeting the RCAteam regarding this incident. In 250 words, what are the main points
you will cover in the report? What

resources or support services can you identify to assist you in

this situation?

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