Recognising and Acting on Clinical Deterioration (Essay Sample)

Title: Recognising and acting on clinical deterioration
Assignment: NUR2100
Due date:
Computer word count: 1840
Recognising and acting on clinical deterioration
Introduction
When patients get admitted to a hospital, they believe that they have gone to a safe place where they will be treated and receive the best treatment. They also hope to get well and their condition normalised or cured or even stabilised. Families and carers of the patients together with the patients themselves have confidence on the medical practitioners, that in case the patients’ conditions deteriorate, the medical practitioners will always be there to provide effective and prompt treatment. However, in some cases, some patients who become or already are suffering from acute conditions end up receiving sub-optimal care. This is because, their deteriorating status is neither recognised, nor appreciated, or even acted upon quickly enough, by the trusted medical practitioners (JBRHA, 2012). The reason for lack of detecting a deteriorating situation is that documentation and communication may be poor. Again, this failure of detecting a deteriorating status can be attributed lack of provision of acute care expertise that is critical as well as lacking experience. Delayed admission to critical care areas and delayed action may cause a patient to deteriorate.
Rationale
Nurses have a very vital and critical role in promoting the best patient outcome. The reason for this is that, when a patient is admitted to a hospital, he or she believes that they are safe, and the carers, the family as well as the patient believe that the best possible care will be provided for them, that in case a patient deteriorates, effective and prompt treatment will be provided (Tornval & Wilhelmsson 2008). This is only possible by appropriately assessing and monitoring patients who are in acute settings. The need for the continuous monitoring and assessment of the patient is so that the nurses can recognise and note when a patient is deteriorating, and correct the condition in time to avoid loss of lives or the patient suffering too much.
There is need to contribute to the nursing dialogue so as to organise systems and nurses in order to maximise outcome as well as deliver safe acute patient care. The importance for nursing assessment and interventions is necessary in order to handle patient events. In the current research done, respiratory complications have been discovered to be frequent, and fatal. Research findings show that early intercession for respiratory issues result in positive patient acute care outcome (Jonsson, Jonsdottier, Moller & Baldursdottier 2011). The need for assessing the nursing care profession and the nurses is to make sure that the care givers embrace and stick to an evidence- based practice, and evidence – based interventions while acting upon a patient whose status is deteriorating. Using a clinical warning tool helps the nurses and care givers to observe any abnormal vital sign that may suggest of even give a cue on a deteriorating patient. This helps in reducing the risk of complications by acting upon the patient immediately, as well as reduces undetected deteriorating patients (Elliott & Coventry 2012).
Theme: Early detection of cues in a respiratory distress situation plays a vital role in preventing patient deterioration.
The course of a patient’s outcome and condition can be enormously altered and changed completely by a turn of events which go undetected or unattended to by a nurse.
Early response to the changes of a patient’s status can prevent the deterioration of the patient’s condition. Respiratory rate acts as an early warning sign of deteriorating of a patient’s condition (Debourgh and Prion 2012). In nurse’s clinical reasoning, time is a vital issue, since nurses are supposed to act fast and make decisions quickly in order to act upon the abnormal findings and rectify any deteriorating situation. For nurses to monitor a patient, it takes more than just recording vital signs, but it includes assessing the respiratory system thoroughly. It also involves a continuous surveillance like the collection of information assessment, constant analysis and interpreting the data (Duff, Gardiner & Barnes 2007).
Role of nurses in detecting the status of a deteriorating patient
Research done in 2005, showed that 11% of deaths reported to the National Patient Safety Agency, were caused by deterioration of patient conditions, which were not recognised by medical care practitioners, or those who were not even acted upon. Therefore, it is the role of nurses to detect the status of a deteriorating patient and acting upon the patient to prevent cardiopulmonary arrest, or even eventual mortality.
Research done shows that the respiratory vital sign has for along time been ignored or taken for granted, and this is one aspect that can help a nurse to discover a deteriorating status of a patient (Henneman, Gawlinski, & Giuliano 2012). Despite the fact that the process of effective detection and acting upon a deteriorating patient being a complex task, nurses have various roles to make sure that the process does not fail:
Nurses should always take formal observations like pulse, temperature, respiration, blood pressure, pulse and even oxygen circulation. It is also the role of a care giver to make basic visual observations like consciousness and colour. For the process of detecting a patient’s deteriorating status and act upon the findings to be a success, nurses are expected to calculate early warning scores correctly, record observations and communicate observations made previously as well as the clinical history of a patient during transfer between departments or wards. Effective communicating concern to the other staff is also vital in detecting deterioration of a patient’s status since most of the caregivers will be on the lookout of the patient in case any signs of deterioration appear. Nurses and acute caregivers need to understand a patient’s past history and recent clinical condition so as to recognise deterioration. Nurses should also endeavour to embark on training to as to arm themselves with the necessary tools of observation and interpretation of a patient’s status and determine if the patient is deteriorating, and what actions should be taken to reverse and stabilise a deteriorating status (Higginson & Jones 2009).
Case study
An elderly man was brought to the hospital by his son, as an emergency, suffering from bouts of dizziness and periods of unconsciousness. Upon examination, it was discovered that the patient is suffering from microcytic anaemia, and has been admitted to the hospital ward for three days now, receiving treatment. The patient has been under care of nurses and doctors and has been receiving treatment, and showing signs of minimal improvement as well as responding positively to medication. However, the nurse in charge of the patient, while doing the routine check up, today the nurse noticed that the patient’s pulse rate was fast. On greeting the patient, the patient made as if to answer, but then did not say anything. That is when the nurse noticed that the patient was having difficulties in breathing. On more assessment of the patient’s condition, the nurse realised that the patient has signs of hypoxemia.
Nursing interventions
In a case like the above, it is always important to put in mind the condition being suffered by a patient, the possible causes for deterioration, as well as the intervention measures to be applied to stop and reverse the deterioration. Hypoxemia, a condition of low blood oxygen has many causes, one being Anaemia. The patient is suffering from anaemia; therefore, the nursing care should bear in mind that the hypoxemia condition can possibly be caused by anaemia (Odell, Victor & Oliver 2009). Nevertheless, the nursing practitioners should not ignore other factors like difficulty in breathing as the causes. The nursing practitioners should do assessment, monitor and intervene to correct the deteriorating condition. Microcytic anaemia is a situation where the blood cells are of normal shape and size, but are few, thereby not being able to manufacture enough blood in the body. The blood is the medium for oxygen and nutrients circulation in the body. Therefore, with a low blood count, it is evident that not enough oxygen is being circulated to the body organs. Lack of enough oxygen in the body disrupts oxygen circulation homeostasis. This deviation from the normal is detected by receptors in the body, which send an impulse to the control centre in the brain. The control centre in turn sends a message to the effectors, the heart, to pump more blood fast, so as to counteract the deficiency of oxygen in the body. The control centre also sends a message to the respiratory muscles with instructions to contact faster, so as to increase the intake of oxygen and excrete carbon dioxide. This causes the heart rate to be fast and in turn making the pulse fast (Preston & Flynn 2010).
In this case, the patient is elderly and does not have enough blood to be pumped fast. This causes fatigue of the heart, and the diaphragm. With aging thoracic cage changes and it reduces the compliance of the chest wall. Osteoporosis caused by age reduces the thoracic vertebrae height. This in turn decreases the ability of thoracic cage expanding during respiration and the diaphragm is impaired from generating effective contraction. This in turn make...