James is an ER triage nurse at a local hospital. On Monday January 4th, 2021, James reported to work as usual at 7:00am. On this particular, he was working with his RN colleague Melissa, who had to take a double shift because Richard (the RN who typically works Mondays) was ill. At roughly 8:30am, a patient by the name of Charles Becker entered the ER, grasping his right shoulder. He approached James’ desk.
“Hi there,” remarked Charles, who was seemingly in pain.
“Hi. What brings you to the ER?” asked James.
Charles explained that he was involved in an accident at home whereby he fell from his porch and landed on his shoulder, which he thinks is now dislocated or broken.
“Ok, let me take your temperature and blood pressure,” said James, preparing the instruments.
“Nurse, can I please have some Tylenol or something. It really hurts,” inquired Charles.
“I will go double check with the doctor,” assured James. “No fever, so that’s good. Your blood pressure will show in a second”
Just then, Melissa joins them in the room, hunting intently for her eyeglasses that she left there earlier.
Nurse Ethics: What are the 5 ethical principles of nursing?
“Hey Melissa,” says James, “do me a favour and record Charles’ blood pressure. I have to quickly ask the doctor something.”
Rushed, Melissa notes 133/88. It actually read, 188/98. Normal blood pressure is roughly 120/80. She then remembers leaving her glasses in the bathroom when she washed her face.
“Hey Doctor Fleming,” says James. “Quick question for you. There’s a-“
“Mr. James,” Doctor Fleming interrupts, “do you not see that I am reading an MRI report? As a nurse, you should recognize the importance of not distracting us physicians when doing important duties such as these.”
James is furious and embarrassed at the same time. He remains silent and begins to walk away.
“Wait,” Doctor Fleming remarks. “What is it now that you are here?”
“An ER patient is requesting medication for pain. Looks like he dislocated his shoulder. Can I give him anything in the meantime?”
“Acetaminophen is fine James,” responded the doctor. “I am going to go speak with the radiologist upstairs for a minute. I’ll be back in a few.”
James returned to the triage area. He gave Charles two extra strength Tylenol caplets and a bottle of water. Charles returned to the waiting room.
After 15 minutes, Melissa calls out, “Charles, you are next.” Charles rises from his chair and quickly collapses to the ground. He begins to violently seizure.
Melissa runs towards Charles, calling out “James, get over here please.” James joins Melissa with some medical instruments to attempt to settle Charles.
“What the hell happened?” James claims, as he straps the blood pressure machine cuff on Charles. “195/125! He is in hypertensive crisis! How can this be? Melissa, what was his bp earlier?”
What are the ethical principles of nursing?
Melissa responds, “I don’t remember exactly, but something stable like 130/85. Wait, let me just check the machine’s memory data.” 188/98.
“If it was that high to begin with, then… oh no… the Tylenol! Acetaminophen will increase blood pressure,” James stated with fear in his voice. James and Melissa knew that Charles needed medication to quickly lower his blood pressure before any organ damage began.
“Okay, I’ll get Doctor Fleming in the back,” Melissa remarked.
“He’s not there. He went upstairs to radiology. We don’t have time Melissa. Just get the clonidine and captopril now!” yelled James.
Melissa stuttered, “B-b-b-but James… we can’t. You know that… I mean, look what just happened because we didn’t double-check.”
Just then, Doctor Fleming turned the corner from the elevator exit. He ordered the administration of clonidine and captopril. Charles came out of the seizure and was immediately admitted for continued care.