NUR4636 – Community Health Nursing

NUR4636 – Community Health Nursing

Case Study

Chapter 29

Issues with Rural, Migrant, and Urban Health Care

Marty, a 75-year-old male, with a history of myocardial infarction called home

complaining of heartburn and running out of antacids. When his daughter-in-law

reminded him to maintain his rest and diet times, Marty grew angry. “Knock it off. I

am doing fine despite what the doctor said. I will care for the diabetes after the

harvest and I will come home as soon as I can.”NUR4636 – Community Health Nursing


Driving his combine formation with other workers for a night harvest, Marty

paused at 9:45 PM for a break while the rest of the combine formation continued

moving forward. Marty’s 6-year-old grandson rode in the combine with him to

experience his first night harvest. No further communication was received from

Marty’s combine.

The boy’s mother called again at 10:00 PM with no answer. Used to “farm

time” and dead space for the cell phones, she was not overly worried but was

concerned about her son being out so late at night. The mother called her spouse

who drove another combine in a different field to find out why the boy was not yet

home. The father dispatched a truck to find Marty while the combines continued

harvesting and gleaning.

The truck driver found the missing combine on its side in a gully with the

lights shining upward. A satellite phone was used to notify the Northern Air

Ambulance and the local 911 of GPS coordinates. The volunteer flight and

paramedic teams were dispatched. The Italian-made Agusta Power-109 helicopter

used instruments to fly over two counties of hilly terrain. The single pilot employed

night vision goggles to study the instrument panel and the radio to keep the pilot

informed of ground rescue operations and hospital preparations. The flight nurses

double checked the laryngoscopes, blood supplies, and jump kits while maintaining

contact with the first scene arrivals NUR4636 – Community Health Nursing

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When the paramedic vehicle arrived, an employee truck was seen driving

away from the combine. Marty was unconscious with a weak, irregular pulse of 100,

BP of 65/48, and respirations of 26. A bruise over the right mastoid is noticed. The

grandson is conscious and crying, splinted for a broken leg. His pulse is 120, BP

138/118, and respirations of 24. Purple circles are seen around his eyes. The 6-

year-old complains of a headache and calls for his mother.

1. How will the nurse gather needed information to effect a successful rescue?

2. What travel and emergency transport resources are available?

3. What rural barriers to diagnosis, treatment, and follow-up resources exist?

4. What roles do rural nursing theory principles play in Marty’s health


5. The nearest critical access hospital does not have a trauma level due to the

lack of a 24-hour staff with trauma training. What types of trauma support

do patient needs indicate? NUR4636 – Community Health Nursing

Also check: Evidence Based Patient Centered Concept Map