Nursing Assessment and Actions - Term Paper Example

Title Assignment NUR2100 Due date: Computer word count: 1972 Nursing Assessment and Actions Introduction Medical related errors are generally symptoms of a dysfunctional health system. According to Radley et al (2012, par1)Medication errors in hospitals are not only common, but also quite expensive and detrimental to patients. Fortunately, at least 25 percent of all medication-related errors can be prevented (Radley et al,2012) especially through the adoption of safe nursing interventions(Lee, and Clancy, 2013). This can go along way if appropriate measures are considered in solving the existing loopholes and deficiencies in health units as well as in the health delivery service (Morley et al, 2006, p.837). One of such measures is proper assessment and early intervention. The role of clinincal assessment cannot be underestimated.When done properly, assessment can significantly reduce medical errors related to both in the human and organization context while ensuring appropriate interventions vital for the safe and suitable care for patients in hospital. Assessment is quite essential in early signs detection and a timely institutional based action, and establishing when and the context or circumstances under which a patient can be safely released from the hospital (Levett et al, 2009, p.514). According to Hunter and Anderson (2008), clinical assessment leads to the diagnosis and management of various pathological conditions and assist nurses and other health practitioners in the evaluation of therapeutic actions/interventions (p.54). According to Levett and his colleagues, failure to have a proper assessment and intervention is the leading cause for adverse patient outcomes (Levett et al, 2009, p.514). This paper aims at enhancing the role of clinical assessment and interventions and how in relation to reducing cases of deaths and undesirable patients’ outcomes. The paper is organized in three main parts. The first section is the background. The second section is presentation of case study with an hypothetical acute situation in relation to the nursing practice. The third section details the various actions in relation to patient’s assessment and interventions. The summarizes with a conclusion at the last section. Case study 1 Jane, a 42-year female patient is admitted in the hospital. She Dyspnea and cough as well as a wheezing sound, which she revealed, tend to increase when under stress. She has also revealed that smokes a lot. Other complaints include stiff neck, tight feeling or sensation in the chest and sore throat. The patient has also disclosed that she has difficulties in doing her daily routing including exercise. She also disclosed that she recently lost her job and has been under a lot of stress lately. She looks confused, sweats a lot and has symptoms of cyanosis. A closer examination revealed that mild swelling of front portion of Jane’s tongue. She is currently under a regular inhaled steroid at a dose of 200mcg /bd and β-agonist treatment. Jane’s peak flow fluctuates between 350 and 420 l/ min between exacerbations. She has also revealed that she is allergic to pets yet she cannot let go her favourite cat named Jerry. Patient Assessment Patient assessment generally entails assessing the severity of the disease, which include confirmation of both the diagnostic and categorization of the type, and severity of the illness. Jane’s case may be related to asthma as indicated by above signs and symptoms. Β-agonist treatment is also indicative of a person suffering from a worsening asthma case (Aldington and Beasley, 2007, par.8). The mild- swollen tongue is a manifestation of phlegm retention. All other symptom are all indicative asthma. Jane’s inability to activity tolerance is linked to inconsistency or imbalance between the supply and demand of oxygen. It is worth noting that all Jane’s may be enhanced by her knowledge decificiency in managing her condition. Jane’s situation may be attributed to several factors including exposure to asthma triggering agents and respiratory infection (Jain et al, 2006, p.317). It may also be a case of lung infection which presents itself with pneumonia-like symptoms followed by respiratory failure(Mery and Turek, 2011.p.78). Jane may as well as showing symptoms associated with its current stressful situation because of losing her job. According to Chiang (2009), Stress tends to trigger and enhances asthma (p.1062). However, frail cannot be ruled out. According to Morley et. al (2006), is is associated with limitation of one’s cardiopulmonary function such as congestive heart failure , obstructive pulmonary disease as well as depression related illness. Nurse’s actions and intervention Nurses’ action and interventions can be done using three main approaches, which include the use of drugs, avoidance of triggers as well as lifestyles adjustment or modifications (Jain et al, 2006, p.320). The nurse is required to undertake a lung function assessment preferably by the use of spirometry, which measures, forced expiratory volume in one s (FEV1).Lung function test is the main area for checking the degree or severity of asthmatic attack and if at all, Jane has asthma, there are more chances that the FEV1 reading will be less than 30% (Aldington and Beasley, 2007). There is also need to check on oxygen saturation levels again using pulse oximetry. According to Aldington and Beasley (2007), in the absence of oxygen therapy, arterial desaturation and hypercarbia can occur at the same time particularly in an asthma case. Normal oxygen saturation values are 97% to 99% in the healthy individual. An oxygen saturation value of 95% is clinically accepted in a patient with a normal hemoglobin level. Using the oxyhemoglobin dissociation curve, an oxygen saturation value of 90% is generally equated with a PaO2, of 60 mm Hg (Johns Hopkins Healthcare, 2011). This should be followed by the administration of oxygen depending on the assessment. The goal is to relieve hypoxaemia by increasing alveolar tension, to reduce the work of breathing, and to decrease the work of myocardium. Oxygen therapy should be given continuously and should not be stopped abruptly until the patient has recovered, since sudden discontinuation can washout small body stores of oxygen resulting in fall of alveolar oxygen tension. The dose of oxygen should be calculated carefully. Partial pressure of oxygen can be measured in the arterial blood. However, there is need to avoid a full saturation of haemoglobin in arterial blood. Arterial PO2 of 60 mm/Hg can offer about 90 percent saturation of arterial blood, but if acidosis is present, PaO2 more than 80 mmHg is required (Johns Hopkins Healthcare, 2011). Oxygen therapy may also be complimented by administration of Heliox, which contains helium and oxygen. It is very useful in facilitating free flow of air, which also causes a decrease in airway resistant to flow of important gases. In essence, Heliox promotes Ventilation while at the same time reducing the work of breathing hence assisting in reducing respiratory muscle fatigue, which in turn protects the patient from respiratory failure. Heliox reduces the inspiratory pressures that the patient (or ventilator) is required to generate during tidal breathing at any given flow and tidal volume. Therefore, heliox may temporise and give definitive treatments (bronchodilators and steroids) time to work. It could also improve the efficacy of definitive therapies if it better carried aerosilised medications to the target airways. Therefore, heliox may affect outcomes in the following two ways: by reducing the work of breathing sufficiently to preclude the need for endotracheal intubation (and/ or to reduce the sense of dypnoea in those with severe airflow obstruction) and as a carrier gas to improve the delivery of aerosols to the airways, thereby improving disposition outcomes (Manthous, 2003). The other important action is to maintain the administration of rapid-acting inhaled bronchodilators as prescribed by the Doctor. Beta2-agonists triggers or stimulate beta2 receptors found on airway smooth muscles which then assist in relieving bronchoconstriction, thus reducing the energy needed for breathing, and clearing way for the inflow and outflow of air (Balkissoon, 2008). Apart from assisting in bronchodilation, Beta2-agonists also help in protecting against stimuli lime allergen or excises which is associated with bronchoconstriction in asthmatic patients (West, 2008, p.11). The importance of Beta2-agonists has also be higlihted by Ducharme , Lasserson, Cates(2011) who state that when adminsitred in proper dose, Beta2-agonists gives a greater protection against exacerbations which requires oral steroids. Inhaled beta2- adrenoreceptor agonists may be administered using a metered inhaler or a dry powered inhaler. But before this, it is important of the nurse to Teach Jane the various methods for inhalers (West, 2008, p.11). The nurse can also consider a combination oral anti-leukotriene agent and Beta2-agonists which is quite beneficial in triggering the anti-inflammatory effect of inhaled corticosteroids thus leading to a more stable and better control of asthma related psymptoms (Ducharme , Lasserson, Cates, 2011, p.3). The nurse is also supposed to out Jane under systemic corticosteroids as prescribed. Corticosteroids suppress airway inflammation. This intervention is one of the first line medications especially for moderate or severe asthma problems (Balkissoon, 2008). The common medication associated with Corticosteroids therapy is drug like prednisolone, hydrocortisone, Prednisone and methylprednisolone. There is need to give or adminstrer these drugs for a period between three to ten days. This should also be followed by a close monitoring of the patient to determine whether there in need for a reduction corticosteroid therapy as depicted by the level of severity of asthma (Aprajita, Panwar and Sharma ,2012). Checking the patient fluid balance is yet another important intervention. Jane may be suffer from dehydration as a result for decreased level of oral intake and loss of insensible fluids through excessive sweating and increased workload because of breathing. There is therefore need to supplement Jane’s fluid but with a lot of caution to avoid overload (Mannix and Bachur, 2007). The other intervention essential for Jane is relaxation. The most commonly used relaxation technique is the breathing excises with a focus on the use of a combination of body and mind. The logic behind this approach is that changes in an individual’s emotional condition can affect the immunological performance (Chiang et. al, 2009,p.1062). To achieve relaxation, the nurse need to make Jane assume an upright position then encourage exhalation of trapped air through a long or extended exhalation and making her exhale freely without applying any force , a bit of counseling aimed at promoting a positive attitude. The nurse is required to check or monitor the Jane’s porgress and how she responds to treatment . For instance, any decline in the lung functions can only be detected through regular check up and aprroriate action taken as many patients often remain asymptomatic until there is conspicuous or significant manifestation of pulmonary faulires(Aprajita, Panwar and Sharma, 2012.p.1050). Nurses in charge are also required to examine Jane’s respiratory pattern until it return to normalcy. The nurse is also supposed to record take note of the observations by having a proper documentation in relation to respiratory rate, rhythm to establish whether trend is under the normal range. The readings can be compared by the first readings taken during the patient admission in order to check for improvement. Monitoring the patient progress is vital in the identification of any deteriorating conditions that can be of great significance in avoiding further complications. As indicated earlier, Jane’s condition may also be linked to her lack of knowledge on the appropriate management for her condition. To solve this, the nurse should provide her with a well-written instructions and procedures for managing her condition. Conclusion The aim of the paper was to describe the nursing assessement and intervention. Using a sample case of Jane, a 42-year-old patient admitted in the Hospital following attack of asthma related complications, the paper illustrates on the role of proper clinical assessment as guidance to the needed actions in relation to treatment and management of the asthma. It is clear that clinical assessment is interrelated to intervention. Therefore, nurses should be more proactive right from the initial assessment of patients, to comings up with appropriate action plans as well as implementing such plans or interventions. If done appropriately, the number of deaths and complications based on errors will reduce significantly. Biblioghraphy Aldington, S., and Beasley, R (2007). Asthma exacerbations 5: Assessment and management of severe asthma in adults in hospital, Thorax Medical Journal 62(5): 447–458. Aprajita, Panwar N.K., and Sharma R.S.(2012). A Study On The Lung Function Tests In Petrol-Pump Workers, Journal Of Clinical And Diagnostic Research. Vol-5(5): 1046-1050 Chiang , Li-Chi , Maa, W., Huang, J., Tseng, L., Kai-Chung Hsueh (2009).Effect of relaxation-breathing training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: A randomized controlled trial International Journal of Nursing Studies 46 , 1061–1070 Ducharme FM, Lasserson TJ, Cates CJ. Addition to inhaled corticosteroids of long-acting beta2-agonists versusanti-leukotrienes for chronic asthma. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD003137. DOI: 10.1002/14651858.CD003137.pub4 Hunter J, Rawlings-Anderson K (2008) Respiratory assessment. Nursing Standard Vol22 (41): 41-43. 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