Prioritization of Care under the Different Medical Circumstance - Case Study Example

Prioritising care Name Institution Course Date Abstract This assignment is about prioritisation of care under the different medical circumstance. It reflects the fact that, being a nurse one will always be experiencing such a task each and whenever attending to patients. Being assigned four patients during one's shift is not a stroll on the beach. The assignment involves prioritising care as per the different diagnoses of the four patients Catherine, George, Clara and John. As a qualified nurse, one has to be smart upstairs when it comes to the prioritisation of care. Nurses have a great challenge of knowing the different levels of prioritisation concerning patient’s problems. However, no matter the situation that may set in a nurse must always be in a position to prioritise care needs. This will help a nurse in attending to patients efficiently. By doing so, nursing goals will be achieved and also the patients will recover easily. Prioritising Care Benner has clearly defined nursing prioritisation as “the advanced skill of judging the relative importance of different aspects of the situation “(Benner, 2010). Diagnoses are given different priorities as they are distinct. Under nursing, there are three priority levels of care. There is first, second and third levels. First level priority problems include airway, breathing, cardiac and circulation problems. This is because they are life threatening issues which if not attended to may lead to death. The second level includes acute pain, safety, mental problem and unusual lab values. The last level includes other health issues other than the ones in the first and second level priorities. It entails problems such as know-how, family adjusting, and activities (Lynn, 2015). Under my case, Catherine is presented having acute appendicitis. It is a condition whereby appendix is inflamed as a result of appendix’s inability to empty efficiently into the colon (Vera, 2012).The pain experienced by Catherine may be associated with two things; swelling of tissues in the intestine or possible existence of surgical incision. Assessment of her pain and note its changes will be my first task. I will also provide correct information to the concerned patient so as to decrease her anxiety. Besides that, I will exercise thorough checking and proper wound as it helps in early detection of any developing infection (Vera, 2013). Gallstones come in when stones start to form in the gallbladder (Rodriguez, 2015). It is also called cholecystitis. Patients with such a problem experience such symptoms as serious abdominal pain, the pain become worse when one eats fatty food, pain on the chest, vomiting, pain also might be experienced on the right shoulder, among others. For George, my first priority will be to relieve the pain he is currently experiencing and to support tests. Secondly, I will concentrate on maintaining electrolyte and fluid balance (Page, 2013). George faces a risk of insufficient fluid volume as a result of vomiting as he complains of nausea. My other aim will be preventing any other further complications that may arise and to give accurate information on the progress of the disease. Additionally, I will maintain correct records of input and output and also to monitor mucous membranes. This will give a reflection on the status of the fluid. Encouraging bed rest will be one of my tasks also as it aids in reducing pressure in the intra-abdomen. Bernstein indicates that children and the elderly are at high risk of getting pneumonia because of their weak immune system (Bernstein, 2015). It is a condition whereby the lung is inflamed likely due to bacterial infection hence affecting the airway clearance. As a nurse, my priorities will be as follows; improving the functioning of her respiratory system, preventing further complications, support her mental recovery process and to give out information on the progress of the disease and treatment. I will place the bed in such a way that it is elevated helping in lowering her diaphragm hence allowing for expansion of the chest. Also, I will check on both depth and rate of chest movement and respiration. Shallow respiration shows a discomfort of the chest wall. Racing heart can be caused after myocardial contractility has been tempered with. Also changes in rate and rhythm. I will monitor every three hours various signs including capillary refill and pulses on the periphery and also the apical one. This will indicate the changes in the cardiac and the venous flow. I will also be looking keenly into both the breath and heart sounds. According to Jhonrok, decreased cardiac output shows that there is a mechanical failure (Jhonrok, 2012). Providing a quite environment will be one of my goals in order to relieve john’s emotional stress. Question2. Vomiting always follows nausea .It causes discomfort and can lead to both extension of recovery time and an increase in costs. Severe nausea can trigger stern complications to critically ill patients to the extent that they can even become life threatening. As a nurse, I always aim at preventing Nausea rather than controlling it. This is because most of the occurrences of nausea can be easily done away with before they develop. George is experiencing a condition called postoperative nausea. This may be as a result of uncontrolled pain or the prescribed opioids that were used to counter the pain. Although efforts have been placed in order to conquer this episode of nausea, there is still a greater percentage of patients globally who experience it after undergoing surgery (Garett, 2015). In Gorge’s case, it is evident that there was a failure in its prevention, and, unfortunately, there is no antiemetic ordered. Garett indicated that antiemetic drugs, when administered, are considered safe compared to others (Garett, 2015). SRA seems to be one of the alternatives. They are considered first- line agents used to prevent and treat postoperative nausea and vomiting. Dopamine antagonists are one of my options that I can use because of its cheap nature. The other one is propofol, which has got antiemetic characteristics. The recent studies have indicated that they are capable of treating postoperative nausea. If George is sensitive to an opioid, I will look for ketorolac that is nonopioid analgesics. Generally, pain medication need not to be withheld as they may cause nausea. Question 3 Serial ECG is a very significant tool in finding any changes regarding a patient. It compares two or more subsequent ECG readings from a patient so as to detect any differences. In order to determine enzymes that contributed to the heart muscle, John’s level of enzymes was under measurement. According to Krucik, human body turn greyish simply due to poor oxygenation (Krucik, 2013). This means that circulation of oxygen in the system has tampered with causing the insufficiency. The greyish colour observed is the blood that has undergone a change from its usual red identity. The primary purpose of blood is to transport oxygen to all tissues in the body starting from the head to the toe. This therefore brings us back to the heart whose purpose is to pump blood by use of its muscular walls. John’s colour clearly indicates that his body has got inadequate oxygen. The heart problem experienced by John may be as a result of an injury to the heart’s muscle. It is a condition that leads to heart’s inability to pump blood efficiently. Inadequate blood in the body results in poor oxygenation in the system. Greyish colour also implies that the cardiac output has fallen causing the reduction in peripheral circulation. On the other side, this reduction diminishes peripheral pulses strength. John experiences a condition called pulseless electrical activity. It is characterised by the absence of palpable pulse, and its unresponsiveness provided electrical activity of the cardiac is in an organized manner. Shah explains that despite the necessity of the electrical activity, it is insufficient to start a mechanical activity (shah, 2013). Under John’s case, the mechanical activity generated by the ventricles is not enough to initiate generation of the palpable pulse. This clearly explains why John did not have a palpable pulse. His ventricles might be experiencing weak contractions or serious peripheral illness. Whitlock defines intubation as the practice involving insertion of a tube into the mouth of a patient down his or her airway (Whitlock, 2015). First, I will intubate him as soon as possible. This aids his breathing as the ventilator will be pressing air into the lungs. Administering oxygen 100% will help correct hypoxia. Blood plasma serves the purpose of transmitting heat throughout the body. When John is carefully examined, it is found out that he feels cool and clammy. Such a condition can be associated with the inadequate supply of blood in the system. The heart problem he is experiencing is the probable reason for the deficiency. His heart is unable to pump the blood effectively all over the body leading to the shortage. Transmission of heat in the body is altered due to inadequacy of blood and hence the cool condition Oxygen is primarily driving factor of a human being. That is why my first priority will be to administer supplemental oxygen to him. This is crucial as it will boost his level of oxygen in his body with immediate effect. As a result, oxygen availability for myocardial uptake will increase. In return, it will support improved contractility of the muscles, reduction of both ischemia and the levels of lactic acid. In nursing, always the position in which a patient is resting matters a lot in controlling different kind of diagnoses. John is leaning on his bed’s left side. This is not a comfortable position to rest. He is likely to experience fatigue on the side he is leaning on. I will, therefore, do the elevation of the bed on the side of his head and then adjust it ensuring that he feels totally relaxed. This kind of practice aids in reducing the demand for oxygen by the body and then thereafter decreases myocardial workload. Complete relaxation also reduces myocardial need for oxygen is hence minimal occurrences of tissue injury. By elevating the side of the head, I will also be facilitating the exchange of gases. Therefore, more oxygen will be pumping into the system. I will also put into consideration pulse oximetry (Vera, 2013). Monitoring it will help in determining whether the respiratory function is adequate. It also aids in the determination of O2 therapy. Additionally, I will engage in measuring cardiac output. On the other side, Cardiac index, contractility, preload, afterload and the work of the cardiac also needs to be determined. TEB (thoracic electrical bioimpedance) technique is one of the various means that I can use in determining if the patient needs special attention. Last but not least, I will ensure that am always prepared throughout my shift in case of anything. For example John’s condition might worsen and, therefore, urgent critical care may be required. A decrease in cardiac output signifies complex complications that may be requiring emergency attention. References Benner, P. (2010). Uncovering the knowledge embedded in clinical practice.web Image: Journal of Nursing Scholarship, 15(2), 36-41. Vera, Matt. (2012). Appendicitis . nurseslabs. web Diana, Rodriguez. (2015). Symptoms of Gallbladder Problems. everyday Health.web Bernstein, Lisa B.(2015). Lung Disease & Respiratory Health Center.WebMD.web Lynn, Jeanie(2015). Delegation and Prioritization.Quizlet.web Vera, Matt. (2013). 4 Appendectomy Nursing Care Plans . nurseslabs.web Page,S.L.(2013). Nursing Care Plan & Diagnosis for Vomiting | Risk for Fluid Volume Deficient & Acute Pain.Registered nurse RN.web Jhonrok.(2012). Nursing Care Plan for "Heart Failure Chronic".Scribd.web Garrett, Kitty.(2015). Managing Nausea and Vomiting.Critical Care Nurse.web Read More