Problem Solving Exercise case study 20-year-old Kim lives with her…

Problem Solving Exercise case study 20-year-old Kim lives with her mother, Kath Knight, in a small regional town in south- western Queensland. Kim was feeling unwell on Sunday this week and told her mother that she was experiencing pain in her leg. She had been kicking a football around the day before, so her mother thought she might have injured her leg during that exercise. Kath told Kim to lie down and gave her an icepack for her leg. After an hour or so, the pain in Kim’s leg had worsened so Kath decided to take Kim to the emergency department (ED) of the nearby public hospital. By the time they arrived at the ED, Kim was complaining of severe pain in her leg. Standard procedure at the hospital emergency department was that patients were triaged on arrival (“triage” refers to deciding about treatment of patients). The triage nurse explained to them that the emergency department was extremely busy and that it would take some time for Kim to be seen by a nurse. That evening, Kim was required to sit in the department waiting room for three hours before being finally attended to by RN Sharon Strzelecki. Kath told RN Sharon that it was unusual for Kim to complain of pain. After speaking briefly with Kath and Kim, RN Sharon advised them that Kim’s pain was a result of the football exercise and sent Kim home to rest. RN Sharon told Kim to return for an ultrasound the next morning. During this time at the ED, RN Sharon did not take Kim’s pulse, blood pressure or temperature, and no blood was taken for testing. At 9.00am the next morning, Kath and Kim returned to the hospital for the ultrasound. After the ultrasound, they expected to speak with a doctor for Kim’s results, but they were told that the hospital was busy due to a shortage of doctors at the local fast-track clinic (which saw less serious cases) and that this shortage had put a strain on the emergency department. Kim complained to her mother of worsening pain. RN Sharon spoke with Kim at the end of her shift at 2:00pm and advised Kath to take Kim home to rest and to phone the hospital back for the results of the ultrasound later in the day. Again, RN Sharon did not take vital sign observations. Just after 6.00pm that evening, Kath returned to the hospital with Kim, who was experiencing chronic pain. This was Kim’s third presentation to the hospital in the past 24 hours. The results of Kim’s ultrasound earlier that day indicated no injury to Kim’s leg. The registered nurse on duty that evening, RN Brett Craig, told Kath to take Kim home to rest, to continue to ice the leg, and to come back in two weeks if the pain had not eased. For the third time, vital sign observations were not taken. The following morning, Kim was brought back to the emergency department by her distressed mother. Kim was unable to walk. The triage nurse immediately took Kim through to the emergency department to be seen by a doctor as she was semi- conscious, unable to answer simple questions, and her skin was mottled. Kim’s vital sign observations were finally taken 30 hours after she first presented to the hospital. She was found to have an infected toenail that had not been identified and she was now in toxic shock with extremely low blood pressure from a disease called necrotising fasciitis. Questions 1. Identify 1.1 Issue: [insert the issue here]

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