Nurses Using Critical Thinking to Implement Patient Care - Essay Example

As the patient is acutely ill, assessment and interventions should proceed simultaneously. Assessment is done by history taking, physical examination and investigations. History taking should include the duration for which the symptoms have been present, the course of illness, associate symptoms such as cough, any obvious or clear triggering event, history of smoking and drug abuse in the recent past, history of significant weight loss and any significant past medical or surgical history. As the patient is having difficulty in speaking due to shortness of breath, history should be taken from the accompanying family member .

The clinical record of the previous day should be reviewed which may contain the history given by the patient. Obtaining the history is important to arrive at the etiology. So far as physical examination is concerned, patient’s vital parameters are recorded and continuously monitored. As patient is hyperpyrexic, hourly temperature recording should be done. Signs of respiratory distress namely tachypnea, use of accessory muscles of respiration, wheezing and findings on chest auscultation are documented (Prigmore 50).

General physical examination includes examination for skin rash and color, needle marks, lymphadenopathy, icterus and diaphoresis. Cardiovascular assessment evaluates blood pressure, heart rate, rhythm, pulse volume status and cardiac murmur, if any. The rationale behind all these assessments is to localize the site of infection, determine the cause of fever and to monitor the respiratory function and progress of the disease. Hydration status of patient should be assessed as fever can lead to significant evaporative losses and dehydration.

Consciousness level and status of the pupils is assessed. Any tests and investigations that have been done till now are reviewed. Patient’s socioeconomic, professional and family background should be briefly appraised. Nursing diagnosis Fever is generally indicative of an infective pathology. Also, the patient has coexisting respiratory distress with diaphoresis. Thus, differentials of the nursing diagnosis in this patient are an acute respiratory infection like community acquired pneumonia of bacterial, viral or fungal etiology (Prigmore 50).

Sudden deterioration with fever, tachycardia and tachypnea suggest acute lung injury. A young patient having a severe illness should prompt a diagnosis of immunosuppresion such as AIDS. Thus, the patient may have HIV related pneumonia and septicemia (Kalikiri, Kandala, and Sachan). Patient’s occupation where he may have been acutely exposed to large amount of dust or noxious fumes could have caused pulmonary inflammation. Construction workers may be predisposed to fungal infections. Fever with sudden onset respiratory distress and diaphoresis can also be a feature of acute infective endocarditis leading to heart failure as a result of intra venous drug abuse (Cabell, Abrutyn, and Karchmer 185-187).

Some drug over dosages can also cause hyperpyrexia with shortness of breath. Non cardiogenic pulmonary edema and pulmonary hemorrhage are known complications of heroine abuse (Gotway et al 120-122; Dettmeyer et al 87). Patient’s lifestyle warrants an evaluation for substance abuse. An unhealthy lifestyle in a young patient can also cause accelerated atherosclerosis and myocardial infarction which is however, unlikely in the absence