International emergency nursing
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Hip-fracture is a common orthopaedic injury presenting to the Emergency Department, particularly within the elderly population. Standards of practice dictating the care of these patients include the early administration of analgesia and an accurate clinical assessment. Once a hip-fracture has been confirmed with diagnostic-imaging, the patient should be transferred to an orthopaedic ward as soon as possible. These standards have been identified from a range of national policies and evidence-based literature. ⋯ There were examples of good practice in this audit, but also areas that require improvement. We recommend that a care bundle be implemented to focus on improvements in pain-relief, pressure-care and fast-tracking.
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Hyponatremia is a common disorder seen in the emergency department and is more prevalent in older adults than in other adult populations (Miller, 2009). Though often discovered by accident, through routine bloodwork, even mild hyponatremia has been shown to have potentially dangerous consequences for older adults, increasing their risks for falls, altered mental status, osteoporosis and fractures, and gastrointestinal disturbances (Soiza and Talbot, 2011). Optimal management of older adults with hyponatremia in the ED involves not only treatment of serum sodium levels and the immediate consequence of the disorder, but exploration and reversal of the causes of the hyponatremia to avoid recurrence. This case study illustrates the clinical presentation, complications and management of hyponatremia in the setting of the emergency department.
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The purpose of this case report is to stimulate debate on the practicalities of detecting pain in patients with dementia in the emergency department (ED) - in this case, a patient who sustained a hip fracture subsequent to a fall in a nursing home. Although case reports are low in the hierarchy of evidence, they serve as useful glimpses into future possible detection and management of the pain status of the person with dementia in the ED who present with injuries such as hip fractures. Older patients with dementia, who are unable to provide a self-report of pain post hip fracture in the ED are at risk for under-detection and under-treatment of acute pain. The utilisation of a specific pain assessment framework, based on best available evidence, will enable nurses to detect and manage acute pain for this vulnerable group in the emergency department.
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This paper reports on the development of an innovative project-the Older Persons' Outreach and Support Team' (OPOST) - within University Hospital of Southampton's Emergency Department. The achievements of this Team are benchmarked against the 'quality, innovation, productivity, prevention' (QIPP) agenda. The demographic changes resulting in the UK's ageing patient population are also discussed in this context.