Following a sudden deterioration in a client's neurological and respiratory status, the primary nurse contacts the critical care charge nurse to expedite a transfer to the intensive care unit. To ensure a structured and comprehensive interprofessional handoff, the nurse sequences the communication using the ISBAR (Identify, Situation, Background, Assessment, Recommendation) tool. Place the nurse's statements in the appropriate chronological order to follow this standardized communication format.
- 1This is Nurse Ramirez from the progressive care unit calling to speak with the ICU charge nurse.
- 2I am calling regarding Ms. O'Connor in bed 8, who is experiencing rapidly progressive respiratory failure and requires immediate escalation of care.
- 3She was admitted yesterday for a myasthenic crisis and has been receiving intravenous immunoglobulin (IVIG) therapy, but her vital capacity has steadily declined over the past shift.
- 4Her latest arterial blood gas shows a pH of 7.28 and PaCO2 of 65 mmHg; she is exhibiting paradoxical abdominal breathing and cannot clear her pulmonary secretions.
- 5I am requesting an immediate critical care bed assignment and the presence of respiratory therapy for an impending intubation.
Answer
The correct sequence follows the ISBAR protocol: 1. Identify (Nurse Ramirez calling ICU charge nurse), 2. Situation (Ms. O'Connor experiencing rapidly progressive respiratory failure), 3. Background (Admitted for myasthenic crisis, receiving IVIG, declining vital capacity), 4. Assessment (ABG shows respiratory acidosis, paradoxical breathing), and 5. Recommendation (Requesting ICU bed and respiratory therapy for intubation).
Effective interprofessional collaboration during clinical deterioration requires structured communication to prevent critical information omissions. The ISBAR protocol provides this structure. 'Identify' establishes who is speaking and to whom. 'Situation' provides a concise statement of the immediate problem. 'Background' offers the necessary context, including the diagnosis and treatments leading up to the event. 'Assessment' delivers the current objective findings (e.g., ABGs, physical exam data) that define the immediate crisis. Finally, 'Recommendation' outlines the specific, actionable requests for the interdisciplinary team (e.g., ICU transfer, respiratory therapy involvement). Placing the statements in this exact sequence ensures safe, efficient, and comprehensive patient handoffs.
Step-by-Step Solution
Key Concept
Collaboration with Interdisciplinary Team via ISBAR Protocol
Estimated Time:1m 30s