Nursing Assessment and Patient Care Essay

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Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of…show more content…
Lily had only recently began dialysis treatment, and her unwillingness to proceed with treatment would have resulted in her care becoming palliative, something the healthcare professional did not think was suitable at this point in her illness trajectory. Tait (2012) points out that a critically ill patient experiences not only physiological trauma, but also psychological trauma. This psychological trauma that can be experienced after critical care has been addressed by the National Outreach Forum (2003) who suggested that services should be developed to address the implications of critical illness. Samuelson (2011) suggests that any negative emotions associated with critical care can be counterbalanced with memories that reinforce safety, control and trust. This is a useful point to consider in Lily case, who fortunately had the time to talk through her worries concerning continual dialysis treatment with the staff on the ward, who were able to convince her she was in the safest possible hands and that continuing her dialysis treatment would be the best option. The psychosocial impact of this event and its repercussions surrounding Lily unwillingness to continue her dialysis treatment is a key aspect to consider when looking at involving Lily in the decision making process. The DOH document “No decision about me, without me” (2012)

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