Deteriorating Patients And Clinical Reasoning

An A to E assessment is the approach to access a deteriorating and critically I’ll patients, each letter stands for an assessment nurses will undertake A- airway B- breathing C- circulation D- disability and E- exposure (Thim, Krarup, Grove, Rohde, & Lofgren, 2012). This essay will look at disability in the A to E assessment of a critically ill patient which will focus on the Glasgow coma scale. The essay will discuss what is the Glasgow coma scale?, Glasgow coma scale is the most common source in monitoring and assessing the neurological statues of a critically ill patient, despite the fact the Glasgow coma scale has limitations on execution it remains the main standard in comprehensive neurological assessment of patients. It

Assessment of a patient is a big process of decision making, it is about the collection of information which will contribute to an overall judgement of a person and the illness they may have. Lloyd (2010) states that assessment is one of the first steps which is needed to be done in the nursing process, it is a building block for a relationship and an ongoing process which lets health professionals gather the correct information to help them understand the problems and needs that the patient is going through. Most of the nursing assessment which are in use today will all have very similar aims. The difference is that how the assessment’s are carried out is where the differences come from.

In this Assessment nursing course, one of the major things that is taught is the most important part of giving proper care to a patient. Correct patient assessment is needed before any nursing care plan or treatment can be implemented. This post-review of a person’s assessment will demonstrate the proper way to go about assessing a person’s health.

Clinical reasoning is embedded in nurses’ thinking for patient care (Levett-Jones 2013). It is a spiral, continuous mental process, underpinned by critical thinking theory and a sound body of nursing knowledge (Levett-Jones 2013). The clinical reasoning cycle includes considering patient’s situation, collecting cues, processing information, identifying problems, establishing goals, taking action, evaluating outcomes and reflecting on the process undertaken (Levett-Jones 2013). Nursing practice for registered nurses is guided both by the National Competency Standard (Nursing and Midwifery Board of Australia 2006) and the Nursing Practice Decision Flowchart (Nursing and Midwifery Board of Australia 2010) to ensure patients’ safety and to optimise care by challenging medical assumptions and facilitating evidence-based practice. The clinical reasoning framework, therefore, allows nurses to prioritise the most time sensitive and specific information, to recognise deteriorating patients and to manage complex clinical situations (Levett-Jones & Bourgeois 2011). This paper will focus on processing information and identifying the two major problems in the case study of Mr. Brown, a 74-year-old man, who was admitted to hospital after a ‘fainting’ episode with chief complaint of dizziness.

With the health care system changing so rapidly, it is important that nurses are autonomous. It is necessary, as patient advocates, that we understand the cause and effect of all entities involving our patients. Critical thinking and making the correct judgment call clinically is vital. A patient situation which comes to mind is an 86 year old female, weighing 50kg, Vital Signs: Blood Pressure: 80/50, Heart Rate: 102 (Sinus Tachycardia), Respirations:

This essay sets out to discuss the importance of comprehensive and accurate assessment on a registered nurses’ ability to make excellent clinical decisions. It will examine what factors can change a nurses’ capability to be aware of, and act on abnormal assessment findings. As well as assessment being part of the nursing process that is used in every day nursing, it is also a critical part of patient safety (Higgins, 2008). Assessment findings are used to determine what needs to be done for the patient next. Early warning scoring systems currently exist to aid in the early detection of patient deterioration (Goldhill, 2005). The rationale for the use of these systems is that early recognition of deterioration in the vital signs of a

The first stage of the process is assessment. Roper et al (2001) refer to this process as ‘assessing’ indicating an ongoing activity; this encourages nurses to recognise the on-going nature of this initial phase. The assessing stage includes gathering information about a patient, reviewing this information, identifying actual and potential problems and prioritising (Roper et al 2001). Roper et al (2001) explain the importance for assessing, as early as possible in the patient’s stay. Extensive, in-depth information may not be gathered on an initial assessment, however any information obtained contributes towards individualised care (Roper et al 2001). Ambrose and Wittig (1998) explain that the initial assessment becomes a foundation for ongoing assessing and holistic care. Barrett, Wilson and Woollands (2009) concord with Roper et al and Wittig in that assessing is an ongoing process and elaborate on this explaining that assessment should not be confused with admission. They state “an admission tends to be a one-off process when you first meet the patient, whereas assessment carries on throughout your relationship with the patient” (pg22). Assessment enables the nurse and patient to identify actual and potential problems. Although, some problems can be directly related to biological needs, holistic needs must be considered, i.e. psychological state and cultural/social standing

Assessment tools are a necessary part of everyday nursing care. They provide the nurse with measurable means of keeping inventory of a patient’s physical progression from shift to shift. Assessment tools like the Braden scale which assess the patient’s skin quality; along with the falls risk scale that assess how high the patient’s chances are for falling; are two common assessment tools used worldwide. Along with these physical assessment tools are an array of non-physical assessment tools used to evaluate anything from the patient’s coping skills to evaluating their stress level. Three popular ones are the

A major component of the care Paramedics provide is the assessment of a patient’s physical status, which is the ground for any further treatment. The assessment method that an Advanced Care Paramedic follows is a systematic assessment referred to as the Primary Survey. The aim of this fundamental assessment is to give an initial diagnosis of the patient as well as identifying any imminent threats to the patient. This assessment is used so that a Paramedic can decide how to treat the patient while staying within the boundaries of their scope of practice. Throughout this essay the concept of a primary survey within the scope of practice of an Advanced Care Paramedic will be understood. Additionally

The purpose of this journal is to reflect on my experience and skills gained during my clinical placement at Ben Taub Hospital. On my first clinical day, I was excited and nervous at the same time. My first placement was in the PREOP/PACU area. I was assigned to help a patient who had been in the PACU area going on 2 days. Normally, once the patient comes from surgery they are only in the PACU area for a short period of time before they are discharged home or given a bed in another area of the hospital. This particular patient still had not received an assignment for a bed. The physicians would make their rounds to come check on him daily. The patient was a 28-year-old Hispanic male, non-English speaking, he had a hemicolectomy. He had a NG tube, urinary Foley catheter, and a wound vac. My preceptor had just clocked in and she needed to check on the patient’s vitals and notes from the previous nurse. Once she introduced me to the patient and explained while I was there, she then asked me to check his vitals. (Vital signs indicate the body’s ability to regulate body temperature, maintain blood flow, and oxygenate body tissues. Vital signs are important indicators of a client’s overall health status (Hogan, 2014). I froze for a quick second. I have practiced taking vitals numerous of times and I knew I could do it correctly. I started with the temperature first, when I was quickly corrected on a major mistake I had made by my preceptor. I HAD FORGOT TO WASH MY HANDS and PUT

More recently, early warning systems have been developed in an effort to recognise the at-risk patient who may be deteriorating

The issue that I will be reflecting on throughout this template will be based upon following the ABCDE assessment when assessing the critically ill or deteriorating patients. This patient will be called Peter for the purpose of this reflection.

Moore (2004) argues that in order to treat patients adequately, nurses should possess a thorough understanding of aetiology, clinical presentations and treatment of the three leading diabetic emergencies: hyperosmolar non-ketotic syndrome, hypoglycaemia and diabetic ketoacidosis. DKA is a life-threatening medical emergency that can result in coma or even death if medical treatment is not administered (Moore, 2004). Prior to insulin discovery, DKA was customarily fatal, with ketoacidotic coma being the usual cause of death (Palmer, 2004). Ketoacidosis occurs due to a deficiency of insulin and an excess of counter-regulatory hormone. Lack of insulin results in reduced glucose uptake

These tools are all reliable, especially in the bedside nursing. Being able to know the patient and the current vital signs are crucial in determining higher care may be needed. By implementing a Modified Early Warning Score (MEWS) can progressively treat a patient who may be deteriorating (Kyriacos, & Jordan 2011). The scoring is

CRITICAL CARE Critical care: the eight vital signs of patient monitoring Malcolm Elliott and Alysia Coventry O ne of the traditional roles of nurses involves surveillance. This might include watching patients for changes in their condition, recognising early clinical deterioration and protection from harm or errors (Rogers et al, 2008). For over 100  years, nurses have performed this surveillance using the same vital signs: temperature, pulse, blood pressure, respiratory rate and in recent years, oxygen saturation (Ahrens, 2008).