Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
Annаbell Flаherty, а 10-year-оld Caucasian female, presented via ambulance tо the emergency department at 1500 оn Friday with a gunshot wound to the right shoulder after being unintentionally shot by one of her parents during a domestic quarrel. The x-ray revealed a fractured distal clavicle. Surgical repair is scheduled for the morning. Annabell's grandmother is with her as her parents are being detained by authorities. An IV was placed and she was started on IV fluids, antibiotics, pain medications, and oxygen. Her wound has been packed and her right arm and shoulder are immobilized in a splint. Assessments: Neurologic: Sensation is intactCardiac: Regular rate and rhythmRespiratory: Clear throughoutGI/GU: Bowel sounds active x 4Integumentary: Within normal limitsOrtho/Mobility: Within normal limits Blood work was done in the emergency department. The results are in the chart. No significantly abnormal labs. CT scan and chest x-ray indicate no lung involvement. The results are in the chart. IVs: Site: Left antecubitalType: 20-gauge Assessment: Patent, intact Fluid: Normal saline infusing at 68 mL/hrDrains and tubes: Site: None Type: Not applicableAssessment: Not applicableWounds: Site: Right shoulderType: Gunshot Assessment: Dressing is clean, dry, and intact. Last circulatory check indicated peripheral pulses strong and equal and capillary refill less than 2 seconds. Last neurologic check indicated that sensation is intact. Shoulder dressing is clean, dry, and intact. An ice pack has been applied over the dressing. Annabell’s grandmother, Grace, is in the room with her. They have both been sleeping on and off. Annabell was just up to the bathroom with some help; she should be tucked back in bed by now Anticipated surgery in AM for debridement, evaluation, and reconstruction. The scenario starts at 0320 Saturday. You enter the room to assess Annabell. As you begin your assessment Annabell asks you the following questions: Why did this happen to me? Will my mommy and daddy have to go to jail? Were they mad at me? Part One: What will you say to Annabell at this time? After talking with Annabell, you continue your assessment. T = 98.2 F (36.8 C)BP = 90/60P = 114RR = 19O2 Sat = 94% (2 L/min via nasal cannula)• Heart sounds: Normal• Lung sounds: Clear• Abdominal sounds: Present• Pulses: Weak Annabell states: I feel funny. I think my ice pack is leaking, I'm all wet. Part Two: What are your three immediate interventions for Annabell?
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