e Case Study Group 1 Daniel Daye Shanique Beharie Kacey Witter TAsia Dallas Christal Walsh Chevelle Senior Naomi Hall-Lodenquai
Case study
74 year old John James visited the
ambulatory care unit for follow up care for a deep vein thrombosis. He has history of peripheral arterial disease & diabetes. He has been taking warfarin at home. Nurse Jennings was asked to do a venepuncture for lab work up. After one unsuccessful attempt to take blood from his left arm she withdrew the needle and applied pressure 3mins.
She then successfully took blood from
the patients right arm. The returned to the unit later that afternoon with a swollen painful left arm and it was noted that blood leaked at the site of the attempted venepuncture. He was complaining of pain. It was noted that blood and localized around his elbow. Panadol was prescribed. It was thought however that the bleeding had stopped. The patients left arm was put in a sling.
Three days later the patient returned with
considerable swelling in his left arm and bruising in the region of the antecubital fossa, spreading down to his hand. At the time there was no suggestion of nerve compression or that the vascular supply was in jeopardy. Six days later however he developed severe pain in his left arm and numbness in his fingers. He was admitted to hospital and the affected limb was treated with elevation and physiotherapy. Despite treatment the patient still had pain in his left arm and hand which was attributed to compression of the median nerve by hematoma
Assessment of a patient receiving
venepuncture
Assessing mental capacity
The Mental Capacity Act (2005) assumes that a person has capacity (the ability to make decisions) unless proved otherwise. Staff should assess a patients capacity to consent to venepuncture. Venepuncture should never be done on a patient that is asleep
Before selection and assessment of
venepuncture site the nurse must first assess the environment in which the procedure will be done to ensure both self and clients safety, proper lighting Ensure all necessary equipment is available. Assess for evidence of an infection Bruising Phlebitis Oedematous limbs
Areas of previous venepuncture
Thrombosed veins, The affected arm in CVA or mastectomy patient pain, warmth, tenderness lump in the area
Identify the errors if any that nurse Jennings/
health team made during the venepuncture attempt. Please include rationales to support your answer
Puncture of vein or artery and damage to
nerves The nurse punctured the vein or artery in the clients left arm and also caused damage to the nerve. This was evident in the scenario as it stated that patient had a swollen painful arm after the venepuncture was done and which resulted in hematoma formation.
Image depicting Hematoma of
venepuncture site
Poor skills of the Nurse
Poor technique on the part of the practitioner can cause hematoma, (Weinstein, 2007).The nurse may not be have qualified or skilled enough to carry out the venepuncture procedure.
Pressure to venepuncture site was
insufficient Inadequate pressure to a venepuncture site can lead to development of hematoma, (Weinstein, 2007). Following a puncture of an artery or vein Pressure should be applied for a minimum of five (5) minutes, (Whitehead, 2010).
Applying pressure to venepuncture site
Explain the ethical principles of
venepuncture and legal implications of nurse Jenningss actions with this case
According to Miller (2003), ethics in
nursing can be describes as a set of rules, principles or guidelines governing nursing practice, conduct and relationships with client and colleagues. Venepuncture; an aspect of nursing, is not excused from these guidelines which stipulate the degree of right or wrong of an action as well as the level of good or bad that results from such an action.
There are numerous ethical principles to be
followed during venepuncture similar to other nursing practices. They are as follows:
Inform and Consent
Maintaining patient confidentiality and privacy Explain Procedure Following the procedure Prevent injury or harm to the client Documentation and reporting
venipuncture complications and special circumstances. Retrieved from: http://arotraining.com/images/Documents/Venip uncture%20Module%206Venipuncture%20Complicati ons%20and%20Special%20Circumstances.pdf
Nottingham University hospitals. (2013). Clinical
nursing ethics. (n.d.)Miller-Keane Encyclopedia and
Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved February 20 2016 fromhttp:// medical-dictionary.thefreedictionary.com/nursing+ethics
Venepunctuire In Adults. ( 2012 , February). Retrieved
from Brighton and Sussex University Hospital NHS Trust: TCP_024_-_Venepuncture_Policy_2009.pdf
Venepuncture. (2010). Retrieved from Eileen Whitehead
2010 East Lancashire HC NHS Trust: http://www.eastlancsdue.nhs.uk/images/Venepuncture.p df
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