The Patient With a Changing Condition Patricia White worked the 11 pm to 7 am shift in a small community hospital. She cared for a patient admitted to the unit during the evening shift who had been...

The Patient With a Changing Condition

Patricia White worked the 11 pm to 7 am shift in a small community hospital. She cared for a patient admitted to the unit during the evening shift who had been involved in a serious motorcycle accident resulting in multiple injuries. Although morphine sulfate 1 mg had been administered intravenously (IV) every hour, the patient continued to complain of pain, particularly in the abdomen. Patricia knew Dr. Whittle, the patient’s physician, did not like to be disturbed during the night; however, she was concerned that the medication had not helped relieve the pain. She called Dr. Whittle and said, “This is Patricia White on 3-South at Mercy Hospital. (S) I am calling about your patient Jim Short who was admitted this evening following a motorcycle accident and is experiencing severe pain. Despite the fact that I have given him morphine sulfate 1 mg IV every hour, he continues to complain of pain, particularly in his abdomen, rating it as an 8 on a scale of 1 to 10. (B) As you recall, he has a fractured left leg and multiple contusions and abrasions. His leg was set in surgery after admission and is currently casted and elevated. (A) His vital signs show some change with a slight drop in blood pressure from 130/80 to 122/72 in the past 3 hours. His pulse is slightly increased from 80 to 88 over that same time period. His abdomen is tense and is the site of the majority of his pain. His neuro signs remain normal. He is alert and complaining. (R) I believe that his condition urgently requires a medical assessment of the abdomen.” Dr. Whittle replied, “Make him as comfortable as you can, and I will be there in 30 minutes. There may be more injury than we first believed. Please, tell him I am on my way and prefer that he not have more medication until I see him.”