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Primary Survey

The first step in the primary assessment is to confirm if it is safe to conduct it in the current condition. There is need to enquire whether the situation is a criminal case. In case the situation was caused by crime, then the assessment should be done but, with authorization from security personnel. However, Mrs. Chan’s case is a safe one since it is her daughter who reported it. (Zideman, 2015). Indeed, it is a condition that she has been managing for some time, considering her regular medication. It is, therefore, safe to conduct her condition.


The next step is to way her responsiveness. Can she talk? Mrs. Chan responded by saying what she remembers during her ordeal. More questions on Mrs. Chan about the amount of pain she feels and where else apart from the leg she feels unwell. Any level of response at this stage is significant including her eye contact.

Mrs. Chan’s airway should then be assessed by listening to her voice or breathing frequency. Medication should be applied if there is any condition that may be blocking their airway system and the next stage should be moved only if her breathing is clear.


Mrs. Chan’s breathing should be listened to assess any breathing difficulty. If nothing can be heard to show any breathing problems, a hand can be placed on her chest or observation of her puffing and panting can also tell her breathing condition. If there is any breathing difficulty, appropriate medication should then be applied to ensure that she has a normal breathing.


Mrs. Chan has a wound due to penetrating glass emanating from a coffee table. Blood flowing from the wound should be prevented as soon as possible to prevent her from fainting due to inadequate oxygen in her brain. Bleeding should, therefore, be stopped using gloved fingers, dressing or a clean piece of cloth. If bleeding is successfully stopped, Mrs. Chan is now ready for medication.

The level of bleeding is the very first assessment that is necessary for Mrs. Chan. The blood flow rate emanating from the wound will help the nurse on duty to understand the level of treatment required by Mrs. Chan (Zideman, 2015). If the wound is bleeding profusely, a first aid activity is firstly important then followed by contacting the team leader.

Blood pressure is another important factor for considering in Mrs. Chan’s case since she has a medical history that suggests she could be suffering from low blood pressure a condition that could have caused her fainting (Zideman, 2015). A blood pressure assessment will also dictate the type of medication to be administered to Mrs. Chan. If her blood pressure is not normal, she should be treated to normalize her blood pressure before any medication is administered.

The amount of hemoglobin in Mrs. Chan’s blood system should be measured. Hemoglobin is the component of the blood that is responsible for blood clotting that helps in healing would. If Mrs. Chan does not have enough amount of hemoglobin, then, blood donation requests are produced, or blood banks are utilized to assist her with hemoglobin.

List the vital sign

Respiratory Rate

fast heart beats.



Flow Rate2O


Systolic BP


Heart Rate



4 Hour Urine Output

Frequent visits to the toilet


Eye contact, stable speech

ADDS Score

Respiratory Rate

O2 Saturation

O2 Flow Rate

Systolic BP

Heart Rate


4 Hour Urine Output



Total ADDS

The feeling of being under emotion or mental pressure because of a situation faced. Anything that causes high demands on a person causes stress.


Hypotension is a blood pressure below for the top number of (systolic) 90 millimeters of mercury (mm Hg) or 60 mm Hg for bottom diastolic.


Hypoxemia is a condition whereby blood contains an abnormally low level of oxygen. This condition can cause tissue disorders as the blood is not supplying sufficient oxygen to the body.


Tachycardia is a condition of increased heart beats that may be due to some factors such as poor blood supply to the muscle.

Pyrexia is a situation whereby the body temperature rises above the normal body temperature.

Panic is a sudden sensation of fear caused by overwhelming feelings.

A nurse is a professional in the medical field who is trained to take care of people in hospitals or the community. Nurses are licensed to manage some medical situations with or without a supervision of a medical doctor (Morton, 2017). A nurse will be the best person to accompany Mrs. Chan because there have the necessary training to handle wounds and care for a patient in Mrs. Chan’s condition. Nurses are also trained on how to prevent injuries when handling patient a situation that will prevent Mrs. Chan from getting more injuries on her. Nurses are mostly used as doctor’s messengers in hospitals a nurse will, therefore, convey the right information to the x-ray physician.

A solvent is an element that dissolves a solute to form a solution. In an intravenous solution of 0.9% Sodium Chloride, sodium chloride dissolves in 1000ml of distilled water to form 0.9% solution. Sodium chloride is a white crystalline powder that is freely soluble in water (Severs, 2015). The final solution contains a pH range of 4.5 – 7.0 and is used for injections. Each 100ml of 0.9% sodium chloride is injection contains 900 mg sodium chloride in water. The solution is mainly used as a single dose for patients and dosage is determined by various factors including age.

Movement of fluids in a human body originates from two types of pressure namely: osmotic pressure and hydrostatic pressure. Osmotic pressure emanates from the movement of fluids against its concentration and through a membrane. On the other hand, hydrostatic pressure is the pressure exerted to counteract the process of osmosis (Helfer, 2014). Osmosis is referred to as the net diffusion of water across a selectively permeable membrane from a region of high water concentration to a region of low water concentration. Body cells are relatively impermeable to solutes but highly permeable to water in the body. When there is a high concentration of solutes on one side of the cells, water moves from the area of small solute concentration to that of high solute concentration to achieve a balance across the membrane.

Crystalloid intravenous solutions are perfect solutions formed from crystalloids such as sodium chloride. They are fluids used in injections because of their ability to penetrate between membranes which are semipermeable (Severs, 2015). There are six types of crystalloid intravenous solutions namely: Half-life normal saline, normal saline, Ringer’s lactate and D5NS. All the mentioned solutions change in concentration apart from the normal saline. Lack of change in concentration in the normal saline solution is the main character as to why it is mainly used for medical purposes. Normal saline crystalloids are then categorized into two groups namely: hypertonic crystalloids and hypotonic crystalloids. Hypertonic crystalloids are mostly used during cases of dehydration, and that is why this class was selected in Mrs. Chan’s situation.

Hypertonic crystalloids contain tonicity higher than the body plasma. Their administration in the blood causes water to move from extravascular spaces into the blood stream thus increase the volume of the intravascular volume (Severs, 2015). During conditions of dehydration, the intravascular spaces are highly concentrated with solutes such as salts hence the shift of water from the extravascular spaces into the intravascular spaces via membranes as the water strives to dilute the solvents in the intravascular spaces.

Active Transport

Passive transport



Sodium-potassium pump

Requires energy

No energy required

(Smith, 2014)

Hydrostatic pressure pushes outward while osmotic pressure pulls in. Hydrostatic pressure forces fluids out of the capillaries by increasing filtration while osmotic pressure pulls the fluids into the capillaries or prevents the fluid from leaving (Helfer, 2014). Hydrostatic pressure is caused by the pressure exerted by blood as in moves against the walls while osmotic pressure exists because of availability of proteins such as globulins, albumin, and fibrinogen in the blood that tend to draw water in capillaries.


Helfer, F., Lemckert, C., & Anissimov, Y. G. (2014). Osmotic power with pressure retarded osmosis: theory, performance and trends–a review. Journal of Membrane Science, 453, 337-358.

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.

Severs, D., Rookmaaker, M. B., & Hoorn, E. J. (2015). Intravenous solutions in the care of patients with volume depletion and electrolyte abnormalities. American Journal of Kidney Diseases, 66(1), 147-153.

Smith, D., Artursson, P., Avdeef, A., Di, L., Ecker, G. F., Faller, B., … & Lennernäs, H. (2014). Passive lipoidal diffusion and carrier-mediated cell uptake are both important mechanisms of membrane permeation in drug disposition. Molecular pharmaceutics, 11(6), 1727-1738.

Zideman, D. A., De Buck, E. D., Singletary, E. M., Cassan, P., Chalkias, A. F., Evans, T. R., … & Vandekerckhove, P. G. (2015). European resuscitation council guidelines for resuscitation 2015 section 9. First aid. Resuscitation, 95, 278-287.