Activity 3
Low risk – High risk Admission Game
Objective:
Nurses & midwifes will participate in a teaching activity to increase their knowledge regarding a drug and alcohol assessment and related risks during an assessment for use
Instructions
- Handout all cards with scenarios to participants (or use projector)
- Lay the risk plates (4) across the floor
- One participant reads out their card (or takes it in turn via the projector), then places it (or indicates which of the risk plates it relates to) on a risk plates. They are asked to explain why on that plate. They may fill in the gaps in the scenario to justify their decision. The group may assist.
- A second participant continues this process until all scenarios are completed the time allocated is over.
Note: There are no right and wrong answers to the game. The aim is to generate discussion and get participants to work through each scenario. Participants may add to the information provided, creating a comprehensive picture of a realistic situation. The facilitator uses the Guidelines Document to generate and add to the discussion.
When working through each case scenario, if the nurse/midwife decides that the patient does not require admission, then the nurse/midwife must clearly identify why there was no or low risk to the patient. On the other hand, if the nurse/midwife thinks the best course of action is to admit the patient, then she/he must provide the rationale behind the decision.
Adapted from Admission Module 2- A Teaching Kit for Nurses - RPA Education Unit CSAHS – Powell, Keen & Brown 1994
Case Scenarios for Low risk – High Risk Admission Game
Cut out each scenario, enlarge to workable size and laminate if possible.
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- A 45 year old female gives a history of the flu for the past three days. She presents with a tremor, fever and sweating. She appears anxious and somewhat confused. The patient gives a history of drinking 8 – 10 middies nearly every day. Her last drink was 48 hours ago.
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- A 30 year old man presents with early signs of pneumonia. He gives a history of drinking 10-12 middies of a Friday and Saturday night when he usual goes out with his mates.
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- A 40 year old unemployed man presents with pins and needles in his legs. O/E he has a large girth, dry skin, conjunctival injection, multiple bruises and palmer erythema. He give a vague history of ‘a few grogs most days’.
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- Stephen, a 15 year old lad, is brought into the Emergency Department by the Police. He was involved in a brawl at the pub. On examination, Stephen was semi conscious, smells of beer and vomit. His parents have been called and are expected to arrive shortly.
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- A 70 year old male is brought into Emergency Department by his brother. The brother gives a vague history that the patient is complaining of seeing things that aren’t there and seems to be confused some of the time.
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- Mrs Oscar, 62 years old, has injured her leg. It is a superficial injury but will required daily dressings. She has a long history of alcohol abuse including a score of 9 on the alcohol withdrawal scale on the CIWA- Ar) during her last admission 4 months ago. Pension day is five days away and she has run out of beer money. Her last drink was 6 hours ago.
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- A fifty year old man is brought in by ambulance having had a fit in the local shopping centre. At the time of presentation he is conscious.
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- Mr Johns, a 45 year old miner, is brought into Emergency by his work mates after falling over in the pub. Mr Johns speech is slurred, he is ataxic and smells strongly of alcohol. His mates are moderately intoxicated.
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- Mrs Zell, a 50 year old computer operator, gives a history of a severe migraine. She says she gets migraines regularly and she normally gets valium and pethidine/morphine from her doctor. On examination, she is clean but poorly groomed. Mrs Zell gives a history of enjoying a whiskey now and then.
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10. Mrs Wait’s husband died 12 months ago. She has no family locally. The community nurse has been asked to see Mrs Wait. On examination, Mrs Wait has multiple bruises and multiple sores. Her clothes fit poorly. The house is filthy and there is no food in the house, only some home brew. Outside there is a pile of empty bottles.
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11. Michael, a 28 year old male is brought in by friend. Michael is reported to be hearing voices. His mates say he has been ‘odd’ for a couple of days, making strange and inappropriate comments.
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12. Mr Heath, a 30 years old sales assistant, is brought into Emergency by his father. Mr Heath admits to a six pack of beer and a bottle of port over the last five hours. He is melancholic, withdrawn and exhibiting signs of depression. Communication is difficult but you manage to ascertain that Mr Heath is very unhappy with his life and is looking for something better.
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13. Cindy has been told by her doctor that she requires a cholecystectomy. Her doctor is aware she drinks two bottles of wine a day.
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14. Amanda presents to the Emergency Department requesting help to get off heroin which she has been using for four years. She has three small children and is their sole carer.
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15. John’s parents bring him to hospital. After 6 years he has finally given up cannabis 3 days ago. He smoked 20 cones a day. He appears slightly agitated, states he is very anxious but is orientated.
LOW RISK
HIGH RISK
NO RISK
DON’T KNOW
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