Emergency Department Patient Assessment and Care Plan - Term Paper Example

Emergency Department Patient Assessment and Care Plan (Insert Name) (Institution Affiliation) The emergency department is the first place a patient brought in is received and is attended to Some patients find themselves in the emergency with life threatening conditions and others with serious medical condition that are not exactly life threatening. The assessment done in the emergency department separates the patients whose condition is more severe than others. For the severe cases, treatment begins immediately after assessment in the emergency department while those whose conditions are not severe are directed to the waiting area; these patients wait to consult the doctor or medical personnel. This is to ensure that life is preserved, since most patients will report to the emergency room, there is need to prioritize the care of the patients with life threatening cases to save their lives. This means that health care is not based on first come first served basis. The assessment and care given by a triage nurse helps to reduce the number of patients who leave without being seen and facilitates patient’s flow (Tsai et. al, 2012). A lot of effort falls on the triage personnel based in the emergency department to assess the patients whose care and treatment deserves first priority. The work of a triage nurse in the emergency department is to assess patients who come in the emergency room based on the severity of the patients. The more severe cases need to be attended to without delays. Given this responsibility, the triage nurse has to check the patient’s vital signs like temperature, pulse and heart rate, breathing; the nurse then inputs the data in a medical chart (Klaas, et al., 2011). The purpose of this paper is to detail, prioritize and give rationales for the assessment of the patient and also to develop, prioritize and provide rationales for a comprehensive care plan for the patient. Furthermore this paper focuses the assessment-based care given in the emergency department. In the assessment based care, you are required to conduct a thorough evaluation of the patient so that you can provide the best care and treatment (Schottke, 2011). These assessments are the basis of the care administered to the patient. This paper is subjective as if focuses on an individual case of one patient. The assessment will be solely bases on the symptoms of the case patients with general medical rationales for the assessment given. The care plan is also subjective and based on the assessment given from the patient. Primary assessment should be carried out initially to determine the extent of the patient’s injuries. When one is assessing a patient one should not be distracted by visually impressive injuries (Nancy, 2011). The Emergency Department psychological department manages psychological or behavioral patients that are admitted unless they are combative or the psychiatric evaluation area is closed. The patient has some symptoms that may suggest a behavioral disorder. This is manifested by the disheveled, unkempt state, the inability to give coherent information about him as well as anxiety and amnesia. These may be symptoms of behavioral disorder but the patient could be exhibiting symptoms from the head injury causing the haematoma and the acetone poisoning. However, it is essential that the assessment of the patient begins with checking the patient’s vital signs like temperature, pulse and heart rate, breathing .The nurse then inputs the data in a medical chart. This medical record forms the basis of the evaluation of the patient (Klaas, et al., 2011). The patient shows symptoms of acetone poisoning. The purpose of the nurse assessment and care is providing supportive cave, prevent further absorption and Promoting elimination of the acetone from the body. Essentially, the priority, method and sequence of the management and care are dictated or based on the Poison and Severity of its presentation. The stages of poisoning described as; (Camacho, 2009). Pre-clinical Phase-some signs may not be visible in this stage of poisoning and priority is given to decontamination of the patient. Toxic phase-in this phase the signs and symptoms are manifested and they guide the treatment. The emphasis is to reduce severity of toxicity and reduce the duration of poisoning. Resolution phase- this phase ranges from peak toxicity to recovery of the patient and the emphasis in this stage is reducing the duration of the poisoning. The patient seems to be in the toxic phase and treatment should be given for the symptoms as well as reduce toxicity and duration of poisoning. This should be followed by ascertaining the product ingested to be acetone, this is because there can potential confusion between acetone and acetonitrile poisoning as both have similar initial features like vomiting, nausea and slowed breathing (Soumya, et. al, 2011). The time of Ingestion and amount ingested should also be gauged from the severity of the patient’s condition. Acetone poisoning is also referred to as Dimethyl formaldehyde poisoning or Dimethyl ketone poisoning or Nail polish remover poisoning. This chemical is readily found in homes and children are prone to its poisoning. Adults are not harmed by small amounts of acetone, however even smallest amount can harm children (Soumya, et. al., 2012). The Acetone poisoning exhibits symptoms like:- low blood pressure, nausea, ,person may, acting as if drunk, coma ,drowsiness, have a fruity odor, sweet taste in mouth, vomiting, stupor ,difficulty breathing, short breath, slowed breathing rate and increased need to urinate. Acetone can get into the body through ingestion, inhalation or through the skin. Acetone irritates the skin membrane and its high concentrations it is a central nervous system depressant. In cases of severe poisoning haemodialysis should be used to enhance elimination of the acetone in the body (Bradberry, 2012). The patient exhibits some of these symptoms like a fruity odour, acting drunk, stupor, pain in belly area (abdomen) and increasing need to urinate (Camacho, 2009). The symptoms are to be treated appropriately as they guide the care plan. There is need to assess and record the mental status of the patient as well as the pupil dilation as patient has haematoma on the right side of his forehead that could be caused by trauma on his head. Trauma is body wound or shock produced by sudden physical injury, as from violence or accident. The patient being conscious needs evaluation on the full extent of the injuries. The elderly are prone to suffer memory related diseases like Alzheimer (Dickerson & Sperling, 2008). There is need for an assessment to determine if the psychological behavior is due to the patient’s ailments and not previous ailments as the patient is unable to give their medical history. The management of head-injured patients admitted to emergency departments is not standardized so the patient's clinical and anamnestic evaluation upon arrival in the Emergency Department with should not stress patients especially those with minor head injuries. (Engel, Heisler, Smith, Robinson, Forman & Ubel, 2009). The patient could be suffering from mild traumatic brain injury, that is most common but failure to properly detect and offer treatment therapies has been linked to chronic complications such as, mood disorders and post-concussion syndrome. It is therefore important to assess and document cognitive and physical symptoms (Bay, 2011). Older patients are prone to fall-related head injuries and head traumas are expected (klass et al, 2011). The patient’s head haematoma therefore is not an isolated case. The patient being elderly therefore could have sustained the haematoma from a fall. A haematoma is caused when blood leaves the circulatory system and becomes stagnant and clotting occurs. Haematoma with 10mm wideness is a sign of internal bleeding. It is important to note that the recovery chances of an elderly patient suffering from a head trauma are dependent on the health condition before the head trauma as well as the age of the patient (Nino et al, 2012). Therefore, it is important to access if the patient has epidural or subdural haematoma which can cause be detected in a physical examination where the pupils are fixed and dilated on the side with the injury. Since the patient has memory loss and loss of concentration there is heed to conduct a CT scan and MRIs to determine the extent of the trauma by imaging. The patient being elderly there is a risk of subdural haematoma and risk permanent brain damage (Klaas, et al., 2011). The key to emergency medical care in poisoning cases is diluting the poisoned substance so much that it lacks the ability to cause harm. The patient needs care and treatment of the symptoms present. This care should be administered to the patient to treat immediate symptoms but the observation of the patient should continue to detect further symptoms that may be repressed. The symptoms guide the treatment plan for the patient. The aim if the emergency treatment is to treat the symptoms as well as reduce toxicity of the poisoning as well as reduce the duration of the poisoning. The care should commence right away by gastric lavage (Bhardwaj, 2011). Gastric lavage should be administered; which is a tube through the nose into the stomach to empty the stomach. This is to empty the contents of the stomach that have acetone and to allow further investigation to the content of the ingested content. Small amounts of water or saline are pumped into the stomach them out. Gastric lavage is preferred to inducing vomiting because acetone is harmful to the skin lining the mouth and the walls of the aesophagus. Precaution should be taken not to drown the patient; drowning occurs when the water pumped in to the stomach enters the lungs leading to a painful death. The rationale behind gastric lavage is that it will reduce toxicity from the patient’s body. However gastric lavage is not routine and should not be administered to all kinds of poisoning patients (Benson et. al., 2013). The patient can also be given activated charcoal. It is used to reduce the absorption of the acetone used together with the gastric lavage; absorption of the poison in the body is greatly reduced thus reducing the duration of poisoning. Activate charcoal has no known adverse effects or risks unlike gastric lavage (Qureshi et al., 2011). The patient should be given oxygen to ensure the patient has a constant supply of oxygen. One of the symptoms of acetone poisoning is the fruity breath; this is how the body helps get rid of acetone and oxygen. When oxygen is given, the toxicity is reduced and the duration of poisoning is decreased. Oxygen is often necessary when the patient is short of breath which is a symptom associated with acetone poisoning. The airways of the patient should be monitored and assessed to ensure that they are not blocked and breathing is not obstructed (Reitz, et al., 2010). Intravenous fluids and glucose solution should be administered to patients with head trauma, this is because inflammation occurs after the injury and sets to motion the healing process Immediately after injury, the body produces more glucose through gluconeogenesis, and burns more fat via lipolysis. Next, the body tries to replenish its energy stores of glucose and protein via anabolism. In this state the body will temporarily increase its maximum expenditure for the purpose of healing injured cells. Replenishing the glucose levels in the patient will help with the recouping process. The glucose level will also reduce the patient’s need to pass urine by increasing the blood solute concentration. It is important for the patient to avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin, because these drugs may interfere with blood platelets, accentuate bleeding problems (Reitz, et al., 2010). The patient should be prepared for CT and MRIs scans to the head to determine the extent of the head injuries to be able to give the right treatment after imaging; this is to ensure the patient receives the best treatment for the injury suffered since physical examination may not always show the true extent of head injuries. Both CT and MRIs scans should be conducted because MRI may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute focal stroke symptoms and is more accurate than CT for the detection of chronic intracerebral hemorrhage (Smith, 2010). Emergency department patient assessment and care plan is essential as it is the first step to recovery. The triage nurse has the responsibility to ensure that care provided helps to recover .in cases of poisoning; the key to emergency medical care is diluting the poisoned substance so much that it lacks the ability to cause harm. This is achieved through gastric lavage and the administration of oxygen. Treatment then focuses on support. The nurse also carries out the first patient psychological evaluation and collects the data in a medical report that forms the basis of the care provided. The symptoms should be treated but the care should also be supportive (Engel et al., 2009). REFERENCES Bay, E.P. (2011). Mild Traumatic Brain Injury: A Midwest Survey about the Assessment and Documentation Practices of Emergency Department Nurses. Advanced Emergency Nursing Journal, 33(1), 7183. Benson, B.E., Hoppu, K. & Troutma. (2013). Position paper update: gastric lavage for gastrointestinal decontamination, Clinical Toxicology, 51(3), 140-146. Bhardwaj, U.B., Subramaniyan, A., Bhalla, A. Sharma, N. (2011). Safety of gastric lavage using nasogastric Ryle’s tube in pesticide poisoning, Health Journal, 3(7), 401-405. Bradberry, S. (2012). Acetone, Medicine Publishing, 40(2), 88. Camacho, M., (2009). Ingested poisons in adults, Nursing Made Incredibly Easy, 7(3), 23-25. Dickerson, B. C., & Sperling, R. A. (2008). Functional abnormalities of the medial temporal lobe memory system in mild cognitive impairment and Alzheimer’s disease: insights from functional MRI studies. Neuropsychologia, 46(6), 1624. Engel, K. G., Heisler, M., Smith, D. M., Robinson, C. H., Forman, J. H., & Ubel, P. A. (2009). Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?. Annals of emergency medicine, 53(4), 454-461. Klaas A. et al. (2011). Rapid Increase in Hospitalizations Resulting from Fall-Related Traumatic Head Injury in Older Adults in the Netherlands 1986–2008. Journal of Neurotrauma. 28(5), 739-744. Nancy, C. (2011). Emergency Care in the Streets. New York: Jones & Bartlett Publishers. Nino, S., Rosalia, P., Giuseppe, C., Luigi, B. & Angelo, C. (2012). Traumatic Brain Injury in an Aging Population, Journal of Neurotrauma. 29(6), 1119-1125. Qureshi, Zeshan, A. & Eddleston, M. (2011). Adverse effects of activated charcoal used for the treatment of poisoning, Journal of Women’s Imaging, 266, 1023–1026. Reitz, C., Ming-Xin, T., Schupf, N., Jennifer, J., Manly, R.M., José A.L. (2010). A Summary Risk Score for the Prediction of Alzheimer Disease in Elderly Persons. JAMA Neurology, 67(7). 1-10. Schottke, D. (2011). Emergency Medical Responder: Your First Response in Emergency Care. New York: Jones & Bartlett Learning. Smith, B.R. (2010). Is computed tomography safe? The New England Journal of Medicine,363(1), 1-4 Soumya, P., Gurleen, S., Debarshi, B., Neha, P., Ajoy, K.K. & Debanjali, S. (2012) Successful Treatment of a Child with Toxic Methemoglobinemia due to Nail Polish Remover Poisoning, Bangladesh J Child Health, 36 (1), 49-50. Tsai, V.W., Sharieff, G.Q., Kanegaye, J.T., Carlson, L.A., & Harley, J. (2012). Rapid Medical Assessment: Improving Pediatric Emergency Department Time to Provider, Length of Stay, and Left Without Being Seen Rates, Pediatric Emergency Care, 28(4). 354–356. Read More