A patient on your team is experiencing difficulty breathing. There is no change in the patient’s status after you elevate the head of bed, apply oxygen, have the patient use pursed lip breathing, and obtain a breathing treatment for the patient. Auscultation of the lungs demonstrates crackles bilaterally halfway up the lungs. The respiratory rate is 40 breaths/min, with an oxygen saturation level of 90% on 4 liters oxygen per nasal cannula. The patient is restless and having difficulty speaking because of the shortness of breath. After exhausting all nursing interventions, you call the physician by telephone regarding the change in patient’s status

1. Describe how you would communicate the following areas using the I-SBAR-R tool. Identification, situation, background, assessment, recommendation/read back/or response.
2. The physician orders Lasix 40 mg IVP and morphine 4 mg IVP and 1 to 2 mg IVP every 1 hour prn. You write down the telephone order and hang up. Your transcription includes the following information:

• Lasix 40 mp IVP Stat and QD
• MSO4 4.0 mg IVP Stat and 1.0-2.0 mg IVP q1hr prn

1. Is this the correct transcription of the order? How would you change it?
2. What tips for communicating with physicians on the telephone can you recall from the textbook chapter? Which of these were missing, done incorrectly, or not done during the communication with the physician? Which steps still need to be done?