Recognizing and Acting on Clinical Deterioration - Case Study Example

Rесоgnizing аnd Асting оn Сliniсаl Dеtеriоrаtiоn Name Institution Rесоgnizing аnd Асting оn Сliniсаl Dеtеriоrаtiоn Introduction The current world is faced with many challenges, including the ones in the health section. This makes medics and other related professionals to stand a platform of recognition for their endeavors and the outstanding struggle that fosters saving the lives of people under critical conditions. It is evident that nursing as a profession, has ascended a higher peg in terms of priorities in the health sector because of the extra prudent services offered to the patients by the officers. Despite the struggle, the inevitable changes in nursing practice have outstandingly placed the patient’s safety in risk due to the questionable nurse’s competence towards deducing the impeding patient deterioration, which might lead to unexpected extended complications or even death. However, the most outstanding preclusion towards such unintended mistakes done by nurses revolves around lessons that must be channeled towards the nurses, enabling them to gain the required knowledge (Mcallister, 2001). This will update them with the current skills and the great ability of observing and interpreting the critical situations, which are considered as the essential key features that are significantly applied in the clinical practice. It must be noted that making keen observations of patients with critical health status is the most primary step in deducing the deteriorating patient and thereby taking the most immediate effective nurse action towards the deduced condition. Reliable and documented sources reveal that lack of knowledge, poor vital sign recording, lack of the most necessitated supervision, as well as failure to report deterioration have individually or jointly contributed towards suboptimal care of the ward patients. Learning from mistakes is the best way of gaining experience and y this, nurses are expected to establish keen observation, implementation of patient safety as well as surveillance are collectively believed to work towards identifying and preventing possible medical errors that go alongside adverse events that may be encountered. Purposefully, implementation of surveillance serves as a detection of the risk as well as the need for the most necessitated intervention y the alerted nurses to both the anticipated and the unanticipated changes in the conditions of the patients. The joint action by both surveillance and observation as endorsed in the nursing practice, clinical rationality is thereby established, which entails clinical decision making and judgments (Dains, Baumann & Scheibel, 2012). A focus on woman, in this context, who seemingly, suffers from the respiratory problems, offers the best example. Rationale Nurses who are observant in the early detection of complications are in a position to minimize negative outcomes for the patient. The earliest the signs can be observed, the better the way can be identified in handling the situation. The primary tests that can be carried out by nurses revolve around checking on the blood pressure as well as checking on the fluid and electrolyte imbalance. Taking note of the vital signs deduced from the observation, however, forms the basal foundation of noting a patient in distress or even the one who is slowly deteriorating. It is evident that a large percentage of the nurses around the globe engage themselves in taking care of a particular patient, having a fundamental sense of what can be the best to be done in a more defined exquisite care (Elliott & Coventry, 2012). For the past few decades, an increment in the number of complications by patients has been witnessed, accompanied by their unexpected death leads to the big question, which revolves around the nurse’s great ability in diagnosing a phenomenon. One of the most outstanding significant sign entails the patient’s deterioration in the fluid and electrolyte balance within the body. The fluid and electrolyte balance within the body determines the process by which energy must be produced within the eukaryotic cells ensuing normal bodily functions are carried out as expected (Levett-Jones et al, 2009). The fluid and electrolyte balance avails the medium through which various processes within the body cells are enabled. The ultimate environment must meet certain conditions, which are to facilitate the carrying out of the entire process. In this case, recording the potential of hydrogen allows baseline assessment of bodily function to be made, which results to deduction of body functionality deterioration. However, it must be noted that assessing as well as managing the respiratory function and the heartbeat rate forms the most important skills that all nurses must be acquainted with. The skills, apparently, incorporates the outstanding clinical reasoning skills, which go alongside other significant nursing skills that are normally applied especially when the patient is experiencing distress. It is still under proclamation that the essential procedural methodology of recording the respiratory conditions has currently been disregarded due to the extreme dependence on the sophisticated machinery, which necessarily takes observation for documentation. Nurses in various health centers with obsolete clinical reasoning skills, most often, fail to deduce the most outstanding impending patient deterioration that ends in ultimate failure to rescue. It is of great significance to prioritize the patients who undergo relatively gradual deterioration, because this can offer the best solution towards avoiding medical errors in a given clinical setting. Clinical reasoning is, therefore, a chain of interconnected critical, intuitive as well as creative thinking in order to preclude the common complications and deterioration (Edwards & Dare, 1996). Case study Mrs. Romney, a 45 year old indigenous Australian widow, was admitted on 25th April 2014 at 10 P.M due to experiencing severe wheezing, anxiety and dyspnoea under Dr. Mark Ting. She was in an emergency department for around seven hours with an acute asthma attack. She can only speak a few words consistently and she rose uncountable complains on her commencement on shortness of breath as well as tightness in her chest when she went back home. However, when a physical examination was carried out, it was deduced that she was making use of her accessory muscles for breathing , has an audible wheezing, the respiratory rate of 127 beats per minute. The arterial blood gas outcomes showed 80mmHg of PaO2, 36mmHg and a Ph of 7.45, indicating that Mrs. Romney was experiencing respiratory alkalosis. It was evident that she has been smoking on and off for around twenty years and just dropped a year ago. Mrs. Romney currently lives near an industrial vegetable factory, which profusely produces smoke endangering the life supporting elements. Identification of the Cues The most primary aspect to be considered in this case revolves around recognition of the right cues as well as clusters of cues, which forms the fundamental basis of the ultimate clinical reasoning. However, it is important to keep on updating the nursing assessment data for the purpose of availing the most appropriate plan of taking care and implementing the most effective interventions in the ultimate evolving situation. In this context, Mrs. Romney is admitted for experiencing persistent wheezing, anxiety and dyspnoea. The risking factor for the exacerbation of her asthma attack, which led to her admission, revolves around her stay near a factor. It is more evident that in a heavily industrialized or even densely populated area, the atmospheric conditions are normally compromised leading to concentrated pollution, especially with the thermal inversions and the masses of the stagnant air. The most reliable and documented sources reveal that such exposures towards pollutants such as the vegetable dust, laundry detergents, pharmaceutical agents, secretions and serums, paints and chemicals in general leads to chronic pulmonary diseases as well as the respiratory cancer. This means that the assessment of an individual’s home that goes alongside relevant environmental aspects is significant in deducing risk factors might have led to injuries or accidents (Odell, Victor & Oliver, 2009). Mrs. Romney’s critical health condition due to experiencing persistent dyspnoea is apparently brought by the exposure to the triggered irritants, which are clinically caused by extreme inflammation that is closely associated with immediate reaction of asthma, which entails bronchial smooth muscle constriction, permeability, increased vasodilatation and the epithelial damage. The anxiety is an expected emotion in her asthma attack. In the assessment of her body conditions, she was observed making use of her accessory muscle for breathing, a respiratory rate of 127 beats per minute among there tests, shows the ultimate symptoms that play a role of the warning signs of a severe asthma exacerbation. The arterial blood gas test-results are clear indicators that she is experiencing respiratory alkalosis due to hyperventilating. Hyperventilation takes place in an asthma attack as the lung receptors respond to increased lung volume due to extreme inflation. On the other hand, the smoking history contributes to the lung disease as well as the respiratory distress, which are major factors in cardiovascular diseases which furthers impairment in oxygenation. With the cues discussed in this section, it is true to say the right patient has been advocated. Up to this extent, it is mature enough for the nurse to prioritize Mrs. Romney as a patient who requires a more necessitated nursing prudence and intervention. Nursing action In preventing Mrs. Romney from the persistent deterioration, the primarily assembled cues during the assessment serves as the guide throughout the health care as well as monitoring abrupt changes in her conditions. Ineffectiveness in her air way clearance must be the first cue to be alleviated for the ultimate purpose of eliminating severe wheezing as well as recovering her normal respiratory rate. In this case, the major intent is to enhance effective breathing pattern that is indicated by the absence of the accessory muscle and pain free inhalation and coughing. Development of the skills and knowledge by the nurses needs to be proactively implemented in the nursing practice so that the patient’s care can be assured as well as delivering in a safe and timely state. Primarily, determination of the baseline respiratory status forms the comparison base point, where the observation of her chest movement, making use of the accessory muscles, noting areas of decrease or absence of ventilation are the most considered ways in evaluating the respiration status. The nurse has to proceedingly administer the prescribed medication as the appropriate procedural guideline and policy in improving the respiratory function (Fabre, 2009). It is important to note that charting and documentation with the administration of medication is quite essential in preventing any medical errors. In fostering improvement of the respiratory rhythm and the rate, the relaxation as well as the breathing techniques should carefully be taught. In addition, the nurse is expected to avail warm fluids and drink that are meat to liquefy secretions and at the same time promoting bronchodilation. Furthermore, her arterial blood gas is supposed to be monitored for the ultimate purpose of precluding the respiratory acidosis. Finally, the important cue to be relieved entails Mrs. Romney’s anxiety, which demands calming as well as reassuring approach that delivers provision of reassurance. Her feelings should further be verbalized and perception and fears are to be encouraged in identifying problematic areas for appropriate planning and implementation of the necessary preclusive measures (Preston & Flynn, 2010). Conclusion Possessing the ability of indentifying as well as prioritizing the clinical problems in particular situations and integration of the stock knowledge and experience forms the basal ground on which a nurse can be able to gain skills and the clinical reasoning. However, all medical interventions are expected to be based on the sound and reasonable clinical assessment of the patient. Having well planned patient-centered intervention avails an evidence of the best quality care. The great ability of nurse in recognizing a particular problem and at the same time distinguishing the needs of Mrs. Romney resulted in the throughout care of her health condition. It is of significance to be multidimensional such that other factors, which contribute to further complications, can primarily be handled in avoidance of persistent of similar situations. Failure in monitoring health problems may sometimes lead to adverse events and thereby affecting the wellbeing of the patient’s post-status. Therefore, nurses are expected to assemble the right cues and take the most effective actions to the right patient. References DAINS, J. E., BAUMANN, L. C., & SCHEIBEL, P. (2012). Advanced health assessment and clinical diagnosis in primary care. St. Louis, Mosby. EDWARDS, G., & DARE, C. (1996). Psychotherapy, psychological treatments, and the addictions. Cambridge, Angleterre, Cambridge University Press. ELLIOTT, M & COVENTRY, A. (2012).Critical care: the eight vital signs of patient monitoring. British Journal of Nursing, 21(10). FABRE, J. (2009). Smart nursing: nurse retention & patient safety improvement strategies. New York, Springer Pub. Co. LEVETT-JONES, T, HOFFMAN, K, DEMPSEY, J, YEUN-SIM JEONG, S, NOBLE, D, NORTON, C, ROCHE, J & HICKEY, N. (2009). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today, 30, 515-530. MCALLISTER, L. (2001). Facilitating learning in clinical settings. Cheltenham, U.K., Nelson Thornes. ODELL, M, VICTOR, C & OLIVER, D. (2009). Nurse’s role in detecting deterioration in ward patients: systematic literature review. Journal of Advanced Nursing, 65(10), 1992-2006. PRESTON, R & FLYNN, D. (2010).Observations in acute care: evidence-based approach to patient safety. 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