Her GCS was 15, pulse 58 and BP 90/50 She was complaining of a pain down her R) leg and you notice that her ankle looks swollen.

Her GCS was 15, pulse 58 and BP 90/50 She was complaining of a pain down her R) leg and you notice that her ankle looks swollen.

Her GCS was 15, pulse 58 and BP 90/50 She was complaining of a pain down her R) leg and you notice that her ankle looks swollen. In addition, there is a skin tear 3cm x 1 cm and is bleeding. She also says that she “feels a little bit dizzy”. What further observations would you carry out?Who would you notify?

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Exam QuestionToday’s date You are a graduate nurse working on Tulip medical ward of Edith Cowan University Hospital.Mrs Vera Brown, UMR No 125647 DOB 21/6/1930Medications:Heparin 5000 units s/c TDSAtenolo l 50mg mane During handover she had a fall in the bathroom at 0700 while trying to get out of the shower. Mrs Brown had been admitted under the care of Mr Saunders following R) THR 7 days ago and was due for discharge tomorrow.You went to Mrs Brown’s aid and assisted her back to bed where you carried out full neurological observations. Her GCS was 15, pulse 58 and BP 90/50 She was complaining of a pain down her R) leg and you notice that her ankle looks swollen. In addition, there is a skin tear 3cm x 1 cm and is bleeding. She also says that she “feels a little bit dizzy”. What further observations would you carry out?Who would you notify?Write in the space below appropriate nursing notes……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..The nurse in charge has asked you to complete an AIMS form. Please use the aims form documentation below.