Question

sbar activity
create an sbar report to report abnormal labs and a change in condition in the scenario:

miss nancy is a 92-year-old female who fell at home. her daughter found her on the ground after laying there for 24 hours. miss nancy has some bruising on her chest, four broken ribs to the right chest, a broken right femur, and has been admitted to the med/surg unit. miss nancy has been alert and oriented (a&o x 4) since admission. when you rounded 15 minutes ago, she was an a&o x 1 and unable to follow commands. you noticed that her breathing was labored and uneven. her blood pressure is 98/62 mmhg, heart rate 128 bpm, resp rate is 40, spo2 86/ra and her temperature is 99.1°f, and she’s moaning. (60 min)

1. what should you report to the provider and why?
2. what do you think might be wrong with miss nancy?

Explanation:

Sub - question 1

1. Situation (S): Report that Miss Nancy, a 92 - year - old female admitted for fall - related injuries (4 broken ribs, broken right femur), has had a sudden change in mental status (from A&O x4 to A&O x1, unable to follow commands), along with abnormal vital signs: BP 98/62 mmHg (low), HR 128 bpm (tachycardia), RR 40 (tachypnea), SpO2 86% on room air (hypoxia), and temperature 99.1°F (low - grade fever). Also, note her labored and uneven breathing and moaning.
2. Background (B): Mention her admission details (fell at home, found after 24 hours, injuries, initial A&O x4).
3. Assessment (A): These changes suggest a possible deterioration in her condition, likely related to her injuries (e.g., rib fractures affecting breathing, possible internal bleeding, or infection) or a new complication like respiratory distress, shock, or altered mental status due to hypoxia or other factors.
4. Recommendation (R): Recommend immediate evaluation by the provider, including possible orders for oxygen supplementation, further lab tests (e.g., blood gas, complete blood count), and imaging if needed to determine the cause of the change. The reason for reporting is that the sudden change in mental status and abnormal vital signs indicate a potential life - threatening situation that requires prompt medical intervention.

Given her rib fractures, the labored and uneven breathing, low SpO2, and change in mental status, she may have respiratory distress or failure due to the rib fractures (impairing chest expansion and ventilation). The low blood pressure and high heart rate could indicate hypovolemic shock, perhaps from internal bleeding (since she was on the ground for 24 hours after a fall). The altered mental status could be due to hypoxia (from poor breathing) or shock. Also, a possible pulmonary embolism (due to immobility from the broken femur) or an infectious process (low - grade fever) could be contributing. Another possibility is a traumatic brain injury from the fall, though the initial mental status was normal.

Answer:

• Situation: Miss Nancy (92 - year - old, fall - related injuries) has new - onset A&O x1, inability to follow commands, labored/uneven breathing, and abnormal vitals (BP 98/62, HR 128, RR 40, SpO2 86% RA, Temp 99.1°F), plus moaning.
• Background: Admitted for 4 broken ribs, broken right femur, initial A&O x4.
• Assessment: Likely deteriorating condition, possible respiratory distress, shock, or hypoxia - related altered mental status.
• Recommendation: Immediate provider evaluation, oxygen, lab/imaging as needed. Reason: Sudden change suggests life - threatening issue needing prompt care.

Sub - question 2