Nancy Smith is 32-year-old patent status post 3 days left knee arthroscopy. Nancy came to the emergency department with complaints of R lower extremity pain, redness and swelling. Nancy states she can feel a large knot on the back of her leg. She is currently taking Vicodin for pain after her recent knee surgery. Nancy is currently not taking any other medications and has no previous notable medical history. Nancy states she has been in a lot of pain since her knee surgery she states she has been unable to sleep and has not been moving around a lot. Nancy states she is in bed and only gets up to go to the bathroom.
Pain: reports 10/10 pain in both of her legs
Nancy is evaluated in the emergency department the follow labs have been drawn:
D-Dimer results are positive: > 2.0
Ultrasound results: pending
The patient is admitted from the emergency department to the orthopedic floor for observation related to post-op pain and rule out DVT.
You are the nurse taking report from the emergency room nurse:
Using this scenario complete the ISBAR
Please give a brief explanation of what each letter stands for and then write out your nursing report using the ISBAR format.
Communicates completely and effectively, including all data from report, noting missing information and recognizing abnormalities.
Effective and efficient interventions are proposed that address patients critical needs.
Information is presented effectively including all points of data necessary for patient care.