The Importance of Detecting Early Cues in Deterioration of Patient Condition - Assignment Example

Recognizing and Acting on Clinical Deterioration Name Institution Date Recognizing and Acting on Clinical Deterioration Introduction Unnecessary death can occur when the condition of a patient gets worse. This situation is most likely to occur in critical care settings although other it can take place in other clinical settings. This is why nurses in every clinical setting need to have the skills of recognizing deterioration signs and be armed with sufficient information on how to handle the situation (Preston & Flynn, 2010). The condition of a patient deteriorates very fast, but basically begins up to 24 hours earlier than a critical phase. This paper will demonstrate a case study with regards to an episode of changes in a patient’s fluid and electrolyte imbalance in an acute care setting where there is nurse involvement. The nurse’s role in detecting the deteriorating state of the patient has been demonstrated and how this may prevent further deterioration. Nurses who are observant in the early detection of complications are in a position to minimize negative outcomes for the patient. Nurse’s Role in Detecting the Deteriorating Patient’s Status Nurses are known to have a central role in the promotion of patient’s optimal outcomes. In order to achieve this, the key element is to appropriately monitor and assess patients within the acute care settings. Issues regarding patient safety as well as possibility of harm when the physical condition of a patient deteriorates unexpectantly have raised concern as demonstrated within the literature (Odell et al., 2009; Henneman et al., 2012). A turn of events that has not been acknowledged by a nurse can obviously change the course of state and outcome of a patient. Monitoring a patient appropriately extends further than recording the patient’s vital signs and entails comprehensive electrolyte and fluid assessment (Wotton et al., 2008). Case Study The case study is about a 68 year old post-operative patient who underwent a laparotomy, is on a ward and is considered to be at risk for hypovolemia. The patient has a history of acute renal failure. The patient’s physical assessment shows oral mucous membranes that are dry, temperature 38.5 degrees Celsius, pulse 112 bpm, blood pressure 102/64 mm/Hg, respirations 25/min, rapid breathing and breathlessness. The patient’s urine is concentrated with an elevated specific gravity. The patient is conscious, quite irritable and appears confused of time and place. Nursing Actions Respiratory assessments are required when the patient’s condition gets worse or in case the patient experiences respiratory symptoms (Higginson & Jones, 2009). With regards to the case study, the patient’s respiration is 25 bpm. This is considered abnormal because it is above the normal parameter which is 15 to 20 breathes per minute. The prompt detection of such an alteration in the patient’s status of respiration is important is requires an early intervention by the nurse. Higginson & Jones (2009) contend that the occurrence of respiratory failure is seen when the pulmonary system is not capable of fulfilling some its roles like gas exchange. With this in mind, it is important for the nurse to note that rapid breathing which is also referred to as hyperventilation can bring about hypovolemia hence prompt intervention is paramount. The patient’s heart rate is elevated (112 beats per minute). This is a common indication in hypovolemia since the normal heart rate parameter in adults is 60 to 100 bpm. Blood pressure is also diminished in people with hypovolemia as seen in the patient (102/64 mm/Hg) because the normal range for BP in adults is 120/80 mm/Hg with an allowance to 10 in both ends. There are various causes of dyspnoea such as physiological, environmental, social, and psychosocial factors. Hence the nurse needs to put into consideration all these factors in order to relieve dyspnoea. The patient needs reassurance concerning the importance of treatment and this plays a key role. Administration of oxygen to the patient can play a significant role in relieving dyspnoea (Higginson & Jones, 2009). According to Higginson & Jones, (2009) physical assessment assists in the reinforcement of the information acquired from the history of patient. This information is handy with the case study because it helps the nurse in evaluation of the patient’s mental condition and establishes whether the patient is aware of time and place. The patient in the case study is confused and is not familiarized with time and place. A patient in respiratory distress is likely to turn into confusion because of extreme hypoxia (Higginson & Jones, 2009). Fear is likely to worsen breathlessness, so, the nurse is required to do her best in order to minimize fear in the patient. This can be achieved through calming the patient and making her feel less anxious. This nursing intervention is applicable to the case study since the relieving the patient’s breathlessness is one of the nurse’s expected outcomes. When assessing the patient, it is essential for the nurse to evaluate the patient’s general look because some clues can be established with regards to deterioration of patient’s condition (Odell et al., 2009). This needs to involve skin color and mucous membranes condition. With regards to the case study, the patient’s oral mucous membranes are dry and the skin color is pale. This is a significant cue for the nurse because it informs her that it is an indicator of dehydration which is related to hypovolemia. Management of dehydration may result in haemodynamic stability (Wotton et al., 2008). Maintenance of a precise and electrolyte and fluid balance in post-operative patients is considered a key element of nursing management (Wotton et al, 2008). Mismanaging fluid balance can turn into significant morbidity or mortality. Data interpretation from patient’s assessments is essential in establishing the degree of care a patient needs, offering treatment as well as preventing a patient’s deterioration from a cause that is otherwise considered preventable (Elliott &Coventry, 2012). Nurses ought to only understand how to measure vital signs correctly; they must also know vital signs’ interpretation and take prompt action (Elliott &Coventry, 2012). Additionally, they are required to integrate extra vital signs while carrying out a patient’s assessment. Nurses are known to conventionally rely on the 5 essential signs for assessment of a patient. The vital signs include: temperature, blood pressure, oxygen saturation, respiratory rate, and pulse. On the contrary, as admitted patients at present are sicker compared to the time before, these indicators which are known to be important may not necessarily be adequate to establish patients whose clinical state is deteriorating (Elliott &Coventry, 2012). Hence, it is highly recommended to do more than just vital signs’ recording. With reference to the case study (a post-op patient at risk for hypovolemia), conducting a comprehensive assessment will be imperative since early detection of cues will enhance early intervention. Surveillance is regarded as a nursing intervention, which has been recognized as a significant strategy in prevention and identification of medical errors as well as unwanted events (Henneman et al., 2012). The Nursing Intervention Classification proposes surveillance’s definition as the purposeful and continuous acquisition, understanding, and synthesis of the patient’s information for proper clinical decision making (Henneman et al., 2012). Surveillance as a term is frequently applied interchangeably with the word monitoring, yet independently surveillance differs considerably from monitoring both in scope and purpose. Monitoring is a major activity in the process of surveillance, although monitoring alone is not sufficient to conduct effective surveillance (Henneman et al., 2012). As an ongoing surveillance, the nurse will monitor the patient’s HR, BP as well as hemodynamic parameters every hour. The rationale behind this is that hemodynamic parameters disclose information concerning sufficiency of fluid volume state. Respiratory assessment is considered as a significant health assessment’s component and is an essential tool in management of patients (Duff et al., 2007). On the contrary several nurses still consider such skills in the medical officer’s domain and not a legitimate activity of nursing (Duff et al., 2007). Auscultation of the chest has not become an element of the practice of nurses’ day to day activity as compared to the basic vital signs blood pressure, respirations, pulse, and temperature (Duff et al., 2007). Yet it is turning out to be increasingly essential as the nursing roles’ scope and the very characteristic of clinical practice transforms; the invention of more technology should not decrease the need for a nurse to use skills of assessment, but instead should increase it (Duff et al., 2007). Monitoring together with treating a patient before emergency admission to ICU has been established to be inefficient (Jonsson et al., 2011). Respiratory system’s problems are acknowledged signs both to emergency ICU admission and to cardiac arrest. The rate of respiration is the vital sign that is least well-documented by professionals of health care (Jonsson et al., 2011). Nurses have cited some hindrances to the respiratory rate’s monitoring as: lack of skill, lack of monitoring tools and time restraints (Jonsson et al., 2011). Patient’s safety can be demonstrated when a nurse applies her knowledge and skills in observations’ recording and interpretation within an acute clinical area thereby preventing unnecessary deaths (Preston & Flynn, 2010). Nurses with experience have developed skills of assessment and clinical insight of recognizing and intervening to prevent patient harm and risk (Debourgh & Prion, 2012). Levett-Jones et al (2010) contend that clinical reasoning that is effective relies on the ability of the nurse to gather the correct cues as well as taking the correct action for the correct patient at eth correct time and for the correct reason. Conclusion In conclusion, this paper has discussed the importance of detecting early cues in deterioration of patient condition. The patient’s overall outcome can be greatly improved through early detection. It is indicated in the clinical literature body that patients can be cared for quite effectively once early signs are intervened upon. However, some challenged exist for the primary health care providers when tackling a patient’s condition. This includes and not limited to poor skills to establish deterioration trends as well as taking appropriate action. To deal with this challenge is having an integrated framework of educational skills, which incorporates assessment, exceptional dedication, and techniques of reflection practice in addition to practice that is evidence-based. The nurse’s role in recognizing deteriorating indicators in the patient’s condition with regards to a post-op patient at risk for hypovolemia have been illustrated in the paper. Reference Debourgh, G. & Prion, S. (2012). Patient safety manifesto: A professional imperative for prelicensure nursing education. 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