Recognizing and Rescuing the Deteriorating Patient - Case Study Example

Recognizing and Rescuing the Deteriorating Patient Name Institution Tutor Subject Date Introduction According to Masters (2014) nurses who are observant in the early detection of complications are in a position to minimize negative outcomes for the patient. Taking for instance the case of a patient who suffers a Traumatic Brain Injury, it is important to note that the initial assessment done by a nurse upon during admission is very critical in survival. Early detection of complications is very important as it enhances possibility of good diagnosis. Early detection help the medical unit come up with preventive measures to avoid further damage. Subsequently, it is important to note that it is very vital in pain management. There are critical cases, i.e. Traumatic Brain Injuries, which need early detection of complications failure to which permanent damage is inevitable. During assessment of patients, nurses play a pivotal role in increasing the chances of survival and even in prevention of permanent injuries. This can only be a guarantee if complications that need urgent attention are detected early. Early detection of hidden complications i.e. during accidents has some time proved to be a challenge to most nurses. This is because of poor assessment techniques applied or used upon admission. This is to show that not just any shallow assessment can prove vital but a thorough one. Thorough in this context applies to a comprehensive assessment done by a nurse to identify any disorders apart from the physical injury or visible damage. Poor assessment of any kind of patients can lead to further complications and eventually death. It is important to note that in-comprehensive assessments and monitoring of patient results to unsatisfactory medication (Urden, 2014). Case Study To be able to go through this work, it is important to create a good illustration to give guidance in relation to the topic understudy. The case study is about Denis. Denis is a patient who suffered a Traumatic Brain Injury after finding himself the object of harassment by a gang while coming from work. He was hit hard on the head by a blunt object and seems to have picked several injuries on the head. He is currently admitted at the Midwestern Regional hospital and put under close watch by the nurses. When Denis was unconsciously taken to the hospital, it was immediately established that he had suffered a severe Traumatic Brain Injury (TBI). He was extremely compromised and could not communicate. This may have been due to either the need for mechanical ventilation or even due to the injury suffered. However, the elementary components of the neurological assessment were undertaken. For the reason that it was acknowledged that delicate findings that could characterize variation in Denis’s status could be missed after a change in shift; joint assessment by oncoming and off going shift nurses was recommended. Elements of the neurologic assessment that were undertaken in the case of Denis included: The consciousness level Respiratory pattern Reflexes Sensitivity to pain Impulsive movement and muscle tone Reactivity and size of Pupil size Muscle tone and posturing Somatic complaints (these are characteristically communicated nonverbally) Discussion According to the Annual Review of Nursing Research (2015), nurses within the neuroscience intensive care unit (ICU) provide various interventions when caring for traumatic patients, such as Denis, who are critically ill. Nevertheless, there only exist a smaller amount of research based evidence which specifically documents the performed nursing interventions. As part of the bigger exploration examining judgment in regard to secondary brain injury, ICU nurses were probed to ascertain mediations regularly carried out when taking care of individuals with TBI. Qualitative as well as quantitative analysis show that nurses, i.e. the ones attending to Denis, frequently monitor hemodynamic factors which include temperature, blood pressure, and oxygen saturation (Hoeman 2008). About 50 % of the time nurses are routinely charged with the responsibility to monitor cerebral perfusion pressure and intracranial pressures. Qualitative analysis from a number of studies show that extra nursing interventions could be classified as interventions to prevent injuries, psychosocial interventions, interventions to preserve a therapeutic environment and neurophysiological interventions. The findings from these series of studies provided substantiation of dimensional function of nurses who take care for patients who had suffered serious head injuries and had as a result suffered a TBI. Safety and quality of patient care can be determined by the work setting in which nurses deliver care to patients. Considered the world biggest healthcare taskforce, nurses uses their experience, skills and knowledge to care for numerous dynamic needs of the TBI patients. A big percentage of the patient care demand is based on the role of nurses (Masters, 2014). Strategies for assessing pain There exist various strategies which are useful in assessment of pain. Some of the strategies utilized in the assessment of pain include use of interdisciplinary teams, search strategy as well as quality judgment (Brown, 2006). Pharmacologic strategies for controlling pain include; Pre-emptive short- acting analgesia Regular long acting analgesics Non-pharmacologic strategies for controlling pain include; Massage and hot packs Physical techniques for example exercise training Psychological strategies e.g cognitive behavioral therapy Nurse role in pain management Nurses perform various roles in management of pain. Some of these roles are in regard to the values gained during professional training while some are just part of human nature. Some of these roles include: assessments of people with pain, identification of the physiological and psychological strengths and weaknesses of the person with pain, provision of information to the community in regard to pain management and Serving as patient advocate with team members to facilitate problem solving (In Hamric, In Hanson, In Tracy and In O'Grady 2014). Therapeutic hypothermia as a treatment modality of Traumatic Brain Injury (TBI) Therapeutic hypothermia refers to an intervention applied in reduction of the core temperature of the body to below 35 degrees Celsius. This approach has gained dominance in the management of acute injury of the brain after a number of small clinical experiments in patients following Traumatic Brain Injury, stoke and cardiac arrest. The most significant characteristic of Traumatic Brain Injury revival is that no therapeutic involvement has been verified to improve outcome (Urden 2014). After TBI, therapeutic hypothermia is normally belated because of investigation, resuscitation and stabilization of the polytrauma patient who may have various instant treatment options. Subsequently it is thought that hypothermia may be contraindicated in the hugely wounded patient for the reason that it has the capacity to contribute to coagulopathy (Annual review of nursing research, 2015). Up to date, eight Meta analyses have been carried out to establish the importance of therapeutic hypothermia in managing TBI. The Meta analyses have indicated that no high quality controlled trials which are random have been undertaken in this topic. They further show that all studies vary in their procedures and that not all researches comprise sufficient allocation randomization and concealment. A Cochrane assessment on therapeutic hypothermia in TBI from 2009 exhibited that there may be therapeutic advantage in the usage of hypothermia in rigorous TBI, with enhanced neurological outcomes and decreased mortality. Nonetheless, important advantage could merely be recognized from low quality trials and consequently the multi-center trials of high quality discovered no statistical variation in the possibility of death following a TBI. This is whether management is undertaken by use of therapeutic hypothermia or not. All of the discussed explorations have assessed the application of early prophylactic therapeutic hypothermia (Urden, 2014). How hypothermia works The objective is to enhance functional outcomes by neuro-protection of neural tissue after an acute injury of the brain. Therapeutic hypothermia is pleiotropic and possible means it is thought to avert the death of the neuronal cell includes: Through creation of a positive balance between demand and supply of oxygen through reduction of the cerebral metabolic rate. Prevention or reduction of the blood brain barrier interruption through reduction of the arteriole permeability thus, consequently, inhibiting the development of cerebral oedema. Condensed free radical development. Reduced inflammatory reaction, comprising a shrink in the release of pro-inflammatory polymorphonuclear leukocyte and cytokines adhesion in the injured brain. A reduction in the seizure activity, which subsequently diminishes the rate of cerebral metabolism and the potential of ischaemia. A decrease in the manufacture of excitatory neurotransmitters, like glutamate. Condensed apoptosis, a pre dominant outcome in all kinds of CNS- Central Nervous System Injury. Methods of cooling Cooling is normally well thought-out under the caption ‘maintenance’ and ‘induction’. Hypothermia induction needs careful preparation of the patient, comprising focal body warming, amplified sedation, and shivering management. Effective techniques for therapeutic induction comprise brisk intravenous combination of intra- nasal nebulized perflourocarbon or intravascular cooling catheters with 20-30ml/kg refrigerated 0.9% sodium chloride (Parrillo and Dellinger 2014). Both of these incur a significant cost. Hypothermia maintenance is normally supplied through surface cooling, without or with closes-loop feedback. A number of these apparatuses are blankets which are re-useable which are less effectual however are not expensive, or water circulating hydrogel heat exchange pads, that are effective but are associated with huge costs. Such approximately cost 500 dollars per patient in the United Kingdom. Low-priced surface cooling with icepacks has the capacity of leading to erratic temperature control with possibility for low and high temperatures and can subsequently be labor demanding. Core cooling is attained by the application of intravascular catheters that bring about quick cooling with dependable closed-looped sustenance of temperature which is preferred. Nevertheless, it entails the usage of an all-encompassing process and has related process- and device- specific risks (Zasler, Katz and Zafonte 2013).On the other hand, extracorporeal circuits like cardiopulmonary bypass circuits can be put to task; such are effective in addition to being fast in attaining hypothermia however are not practical in the intensive care unit (ICU) situation and extremely insidious. It is normal to use a permutation of cooling (maintenance) and core (induction) approaches to attain the preferred brisk cooling and then to offer sustenance of hypothermia. It is important to point out that traumatic brain injury (TBI) is a key cause of disability and death globally (Greenblatt 2010). Every year in the European Union (EU), TBI accounts for approximately one million hospital admissions, for the majority of the 10000 severely impaired severely impaired victims as well as 50 000 road traffic deaths. The long term morbidity of the disease and mortality are consequently related to an enormous societal and financial. Approaches to enhance outcome thus possess an essential role in the sharp management of TBI patients. Conclusion Early recognition of a patient’s complication before they become problematic is important in survival. A registered nurse applies a methodical, dynamic approach to gather and evaluate information about a patient. Assessment of the patient is not merely limited to data in regard to physiological elements, however the psychological data, lifestyle factors, sociocultural and economic elements are additionally vital. For instance, the pain assessment in the case of Denis can’t just be constricted to the physical manifestations and causes, but his response too. Response in this context implies request for additional pain mediation, fear, anger directed to the hospital workforce, withdrawal from family members, refusal to eat and even inability to get out of his bed. The nursing diagnosis turns out to be the clinical judgment of the nurse in regard to response of the patient. The diagnosis not only shows that the patient is experiencing pain but additionally exhibits that a patient has created some additional hitches- for instance poor nutrition, anxiety, and conflict with family. Consequently it can imply the possibility to develop drawbacks. For example an immobilized patient faces a potential hazard in case of a respiratory infection. For this reason it is important to note that the diagnosis is the foundation for the care plan used by a nurse. Centered on the diagnosis in addition to assessment, a nurse is able to set a scalable and attainable short and long term objectives for the patient. This may include pain management through sufficient medication, counselling as a means of resolving conflict and provision of frequent little meals as a way of sustaining an adequate nutrition. References Morganti-Kossmann, C., Raghupathi, R., & Maas, A. I. R. 2012. Traumatic brain and spinal cord injury: Challenges and developments. Cambridge: Cambridge University Press. Masters, K. 2014. Role development in professional nursing practice. Burlington, MA: Jones & Bartlett Learning. Zasler, N. D., Katz, D. I., & Zafonte, R. D. 2013. Brain injury medicine: Principles and practice. New York, NY: Demos Medical Pub. Hoeman, S. P. 2008. Rehabilitation nursing: Prevention, intervention, and outcomes. St. Louis, Mo: Mosby/Elsevier. Annual Review of Nursing Research .2015: Traumatic brain injury. (2015). Place of publication not identified: Springer Publishing. In Hamric, A. B., In Hanson, C. M., In Tracy, M. F., & In O'Grady, E. T. 2014. Advanced practice nursing: An integrative approach. Urden, L. D. 2014. Critical care nursing: Diagnosis and management. St. Louis, Mo: Elsevier/Mosby. Parrillo, J. E., & Dellinger, R. P. 2014. Critical care medicine: Principles of diagnosis and management in the adult. Philadelphia, PA: Elsevier/Saunders. Zasler, N. D., Katz, D. I., & Zafonte, R. D. 2013. Brain injury medicine: Principles and practice. New York, NY: Demos Medical Pub. Greenblatt, J. M. 2010. Answers to Anorexia: A Breakthrough Nutritional Treatment That Is Saving Lives. North Branch: Sunrise River Press. Read More