Workplace Violence: Which Role Have You Played?

In this

issue

NURSING SCIENCE

Prevalence of lateral violence in nurse workplace: A systematic review and meta-analysis

Workplace Violence and Incivility in Graduate Nurses – How Are We Addressing It and What Should You Do?

Incivility and Bullying in the Workplace

Workplace Violence in the Emergency Department

PROFESSIONAL DEVELOPMENT

Workplace Environment Council

What Should I Do When Facing Lateral Violence?

Preventing Lateral Violence at Houston Methodist

Workplace Violence: Which Role Have You Played?

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

pH

7.26

(7.35-7.45)

PaO₂

83

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

pH

7.32

(7.35-7.45)

PaCO₂

40

(35-45)

HCO₃

20

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

pH

7.49

(7.35-7.45)

PaO₂

94

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

BE

+2

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

pH

7.51

(7.35-7.45)

PaO₂

95

(80-100)

PaCO₂

42

(35-45)

HCO₃

30

(22 – 26)

BE

+3

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

FROM OUR TEAMS

Workplace Violence: Which Role Have You Played?

By Camille Asamoah, MSN, RN-BC

“How come you are so slow?” “I needed my patient’s transfer request put in yesterday!” “This is just one of the many reasons why I hate working when you are the Unit Administrative Assistant (UAA) for the shift!” “I am going to tell the manager that you are refusing to help me!” These unkind words can be an example of bullying, incivility and workplace violence. Workplace violence is an ongoing issue that does not just involve physical violence. Workplace violence can be a written, verbal or physical threat or attack that is intentionally done to bring a sense of intimidation, bodily injury or even death.

As a UAA, a colleague, a human being and a Houston Methodist employee, workplace violence is something that should not be tolerated. No one has the right to speak to someone in a hostile way because they think that the role is “lesser than” theirs. If you are currently experiencing any kind of workplace aggression, bullying, incivility, threats or any other issues, please speak up. Go to your leadership and tell them the situation that has occurred. Bullying can come in all forms and from all levels. If you feel intimidated, there is also a workplace violence report that can be completed on the intranet. As a UAA, you are the eyes and ears of the unit. It is important to be observant at work and note anything that seems inappropriate. As we have unfortunately recently seen with the Dallas hospital shootings, workplace violence can also be brought on by a patient’s family member or visitor. This makes it even more important to be observant when it comes to the comings and goings of your unit. Do not hesitate to call security if you notice anything out of the ordinary. Most importantly, stay safe.

Related Articles

Preventing Lateral Violence at Houston Methodist

PROFESSIONAL DEVELOPMENT

Workplace Environment Council

Contact us at CNREPHelp@houstonmethodist.org

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