Failure To Adequately Assess And Monitor The Patient Post-Op

Failure to adequately assess and monitor the patient post operatively resulting in the patient’s death

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PLEAE READ BEFORE SUBMITTING TO DO IT. i NEED EXCELLENT WORK AND PROFESSIONAL GRADUATE LEVEL CASE STUDY WORK. Case Study #1: Failure to adequately assess and monitor the patient post operatively resulting in the patient’s death NOTE: There were multiple co-defendants in this claim who are discussed in this scenario. While there may have been errors/negligent acts on the part of other defendants, the case, comments, and recommendations are limited to the actions of the defendant; the nurse. The decedent/plaintiff was a 67 year old male who underwent a right total knee replacement. Following the procedure, the plaintiff was treated in the post-anesthesia care unit where an epidural catheter was inserted for postoperative pain management.Following one episode of hypotension which was treated successfully with ephedrine, the plaintiff was discharged to an inpatient medical-surgical care nursing unit with the epidural in place. Although the defendant nurse customarily worked on the post-acute critical care unit, she had been re-assigned to the medical-surgical nursing care unit. The defendant nurse stated that she understood her assignment at the time of the plaintiff’s admission to this unit was to provide oversight of the patient care on the entire floor for that shift. The defendant nurse assessed the plaintiff upon his admission to the unit and found him to be stable. The defendant nurse understood that the direct care of the plaintiff was assigned to a c-defendant licensed practical nurse (LPN).Approximately three hours after arriving on the unit, the plaintiff was unable to tolerate ordered respiratory therapy due to nausea and vomited shortly thereafter. According to the defendant nurse, approximately ten minutes after the episode of vomiting, the LPN found the plaintiff cyanotic and unresponsive and immediately called a code. The defendant nurse responded, as did the code team, and the plaintiff was intubated and transferred to ICU. This account of events was disputed by the LPN and two other staff on the unit who understood that the defendant nurse was responsible for the direct care of the plaintiff. The LPN stated that it was the defendant nurse who found the plaintiff to be unresponsive at some point after the episode of vomiting and called the code herself.The elapsed time between the episode of vomiting and the code is also disputed. The eventual diagnosis was anoxic encephalopathy due to the time that elapsed before CPR was initiated. The prognosis was poor and life support was withdrawn. The plaintiff breathed independently and was transferred to hospice care where he subsequently expired. Ordered vital signs and checks of the xyphoid process were not documented.The fact that the plaintiff had experienced hypotension in the recovery room should have warranted even closer observation. The episode of nausea and vomiting should have resulted in additional observation and notice to the physician. Resolution Experts for the plaintiff presented testimony that the defendant nurse had breached the standard of care. The jury found the defendant, a representative of hospital negligent and awarded compensatory and punitive damages to the plaintiff and against the defendant, a representative of the hospital. Discussion 1.

Summarize the case and the verdict. 2. Based on your review and summation, do you agree with the court’s decision? Defend/discuss your answer. 3. What practice-related legal and/or ethical issues as they pertain to Health Care management were breached? How? By whom? Include the nurse as well as ALL other possible defendants. DEFEND your answer.4. Identify, document, and explain [in detail] a risk management action plan to prevent this type of issue(s) from reoccurring. Refer to rubric for information on what is required for an action plan.

Paper For Above instruction

The case revolves around a 67-year-old male patient who underwent a right total knee replacement and subsequently experienced a tragic and preventable death due to inadequate post-operative assessment and monitoring. The core issue lies in the lapses of nursing care, particularly by the defendant nurse, in recognizing and responding promptly to symptoms of deterioration, namely nausea, vomiting, and cyanosis, which culminated in anoxic brain injury and death. The court convicted the defendant nurse and hospital of negligence, awarding damages to the plaintiff’s family.

To summarize the case, the patient was admitted postoperatively with an epidural catheter for pain management. Initially stable, he experienced hypotension in recovery, which was managed successfully. However, within three hours on the medical-surgical floor, he developed nausea and vomiting. Subsequently, he became unresponsive and cyanotic, with a disputed account of whether the defendant nurse or the LPN was responsible for recognizing his deterioration and initiating emergency response. The time delay in recognizing and intervening contributed to hypoxic encephalopathy, leading to his death. The lack of proper documentation and inadequate monitoring compounded the failure to provide appropriate care.

The court’s decision to find the nurse and hospital negligent appears justified based on the evidence demonstrating a breach of the standard of care. Comprehensive nursing assessment protocols, vigilant monitoring, timely recognition of changes in patient status, and immediate intervention are fundamental nursing responsibilities. The defendant nurse’s failure to escalate concerns or document vital signs appropriately indicates a lapse in professional standards. Moreover, systemic issues such as unclear assignment responsibilities and insufficient staff training contributed to the outcome.

From an ethical standpoint, the breach of principles such as beneficence, non-maleficence, and accountability is evident. Healthcare providers have a duty to protect patients from harm through diligent monitoring and prompt response to deviations from expected recovery. The lack of thorough documentation and communication failures further undermine ethical obligations of honesty and transparency. Legally, these breaches expose healthcare institutions to liability, emphasizing the importance of strict adherence to protocols and ethical standards.

Preventing similar incidents requires a comprehensive risk management strategy. First, establishing clear care protocols for post-operative monitoring, including specified frequency of vital signs and neurological assessments, is essential. Implementation of standardized checklists and alerts for abnormal findings can assist staff in early detection of deterioration. Regular staff training sessions and competency evaluations are necessary to reinforce intervention skills and awareness of complications associated with epidural use. Encouraging a culture of safety where team members feel empowered to escalate concerns without hesitation is crucial.

Moreover, documentation practices must be standardized and reinforced through periodic audits to ensure completeness and accuracy. Utilizing Electronic Health Records (EHR) systems with decision-support tools can facilitate timely alerts for abnormal vital signs or symptoms. Interdisciplinary communication should be optimized through structured handoff protocols to prevent overlooked clinical changes. Finally, incident review committees should routinely analyze adverse events to identify systemic vulnerabilities and implement corrective actions promptly.

References

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