As you work through this case study consider the following questions:
What areas of transitions of care place the patient at the greatest risk for harm?
According the National Transitions of Care Coalition (2008), improving communication in transitions of care, implementing standardized electronic medical records, establishing points of accountability for sending and receiving care, and expanding roles of pharmacists in transitions of care all aid in the continuity of care and result in positive patient outcomes. However, often the expectations of transitions of care fall short because team members are unsure of their role and the information that should be relayed. The patient’s risk for harm may have been increased when she was discharged
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Often in rehab facilities, tasks are delegated to nursing assistants, who are not allowed to make assessments, but who also are not educated to be looking for slight changes in patient condition. Increased agitation and confusion can be attributed to lack of sleep, poor nutritional status, or even be considered a normal fluctuation in the patient’s dementia and may not be reported to a nurse. Oliguria and odor of urine may not be noticed by an aid in the event that the patient load was heavy, and is something that an aid may not realize is a critical factor to be reporting to the nurse on. Lastly, when a patient may not be able to express pain verbally, it requires healthcare providers to be familiar with them and make astute judgements based on their behaviors, vital signs, and overall affect/appearance to know that they are in …show more content…
Signs and symptoms greatly depend on the initial site of infection, the causative microorganism, the underlying health history and status of the patient, the pattern of acute organ dysfunction as well as the period of time from initial onset to initiation of treatment (Angus & Van der Pol, 2013). However, classic Signs of sepsis may include but are not limited to fever, hypotension, cloudy-blood tinged urine, oliguria with sequential anurina, delirium, tachycardia, tachypnea, skin pallor, decreased temperature in extremities due to inadequate perfusion, increased lactate as well as altered blood glucose levels and blood cell
Also, cytokines are used as they can destroy the infection, however there is a problem with this diagnosis as excessive production can cause tissue and organ damage. The pathological physiological outcomes of sepsis is that there is a multi-organ dysfunction that includes the heart, brain, kidneys and the lungs. Acute respiratory distress syndrome (ARDS) is a condition where there is a low oxygen level in the blood, this mostly affects the lungs, people who have sepsis will be affected by ARDS as their breathing rate will decrease. Another reason for multi-organ dysfunction is that there is a lack of blood being given to the organs, this causes low blood pressure or as it’s called hypotension, this mostly affects diabetic people which leads them to having sepsis.
Unfortunately, infection places people in the hospital and infection is developed in the hospital. Two ways to contract sepsis are through hospital-caused infection, like in Amy Widener’s case, and through an infection caused by outside sources, for example a urinary tract infection in an elderly person. Everyone is capable of getting sepsis however cases appear most often in children under one year of age and in elderly older than sixty-five years. This is due to the body’s immune system being weaker in these demographics than in a person that has a built-up and strong immune system (“Sepsis Questions and Answers”). Sepsis occurs because of infection so the immune system plays a large role in the body’s defense mechanism. When people with already compromised immune systems develop an infection or are in an environment that infection is likely to occur, for example an unsanitary procedure in a hospital, then the body’s chances of being able to fight the infection off are greatly
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
The framework of this model is utilized throughout hospital settings to form a basis for all nursing decisions in respect to nursing diagnosis, care plans, discharge planning, and quality assurance (Reynolds & Cormack, 1991). This conceptual model focuses on the effects of internal and external environments that contribute to someone’s behavior. Pain (being the internal force) in patients with altered mental status usually manifests externally in non-verbal cues. Nursing as the external force can use tools that focus on the non-verbal cues given by the patients to accurately assess the pain and properly treat it.
When a patient is unable to make care decisions for themselves, it is necessary to involve those closest to them, most often family members. Providing a supporting environment to family members is another way that the best interest of the patient can be maintained. Families and friends can make a huge difference in the life of the patient after discharge. Instructing families in a way that is easy to understand helps eliminate potential barriers to communication. Families should be aware of what things to look for, what would constitute an emergency, and how to safely handle
Many great historical figures of the scientific community have written on the subject of the same perplexing disease over the centuries (Angus, van der Poll, Finfer, Vincent 2013). Sepsis has been given many names, origins, and etiologies. In the 4th century, Hippocrates declared the disease the cause of organic decomposition, wound festering, and swamp gas (Angus et al. 2013). During the 19th century, Louis Pasteur theorized the disease was the outcome of a pathogenic microorganism in the bloodstream, which resulted in a body-wide infection (Angus et al. 2013). In the 21st century, the medical community made a breakthrough with the discovery of the disease’s link to the inflammatory response system and devised a plan of action to combat the high mortality rates among those infected (Angus et al. 2013). According to Hotchkiss, Monneret, & Payen (2013) the effects of sepsis are well documented, while the molecular processes it utilizes are still being explored; however, new studies are helping to expand our understanding of the centuries old disease.
I am mostly reflected in William Bridges’ model of transition - ‘Managing Transitions’. This is due to the experiences that I have had in transitioning from the use of manual drug dispensing and recording systems to automated drug dispensing and recording systems. The transition followed a decision by the hospital management to change the manual drug dispensing techniques to the use of McKesson AcuDose-Rx® which is an Automated Medication Cabinet incorporating a number of features to make it a very useful tool in the nursing profession.
There are six set standards of the nursing practice; assessment, diagnosis, outcome identification, planning, implementation, and evaluation (ANA, 2010; pp. 9-10). Throughout a typical shift on the unit I work for, I have set tasks I am expected to complete in order to progress the patient’s care, and to keep the patient safe. I begin my shift by completing my initial assessment on my patient. During this time, I am getting to know my patient and assessing if there are any new issues that need my immediate intervention. From here, I am able to discuss appropriate goals for the day with my patient. This may come in the form of increasing mobility by walking around the unit, decreasing pain, or simply taking a bath. Next, I plan when and how these tasks will be able to be done, and coordinate care with the appropriate members of the team; such as, nursing assistants and physical therapists. Evaluating the patient after any intervention assists in discovering what works and what does not for the individual. “The nursing process in practice is not linear as often conceptualized, with a feedback loop from evaluation to assessment. Rather, it relies heavily on the bi-directional feedback loop...
For the purpose of this assignment, a case study has been selected in order to relate the signs and symptoms of sepsis to the underlying pathophysiology of the sepsis continuum. In order to maintain patient confidentiality, names dates and times have been changed or omitted, in line with Australian Nursing and Midwifery Code of Professional Conduct (ANMCC, 2008).
Another role of a nurse is to be the patient’s advocate and “eyes and ears” of the doctor. The nurse gathers first hand information from the patient and reiterates it to the doctor. The nurse and doctor work together to find a diagnosis. Verbal communication between doctors and nurses are essential to provide a successful outcome for the patient. Barrett, Selman, and Thomas (2005), believe verbal communication between nurses and doctors is viewed as necessary for “joint decision making based upon shared professional perspective’ which enables those involved to articulate their own perspectives, listen to the views of others and negotiate outcomes’” (as cited in Astbury, 2008). If there is weak verbal communication or tension between doctors and nurses, the workplace can become negative. A negative relationship between doctors and nurses and poor verbal communication can cause frustration and potentially harmful outcomes for the patient. The Centers for Disease Control and Prevention released a list of the leading causes of death in the United States and deaths due to medical errors was third (Neese, 2015). In 2013, The Joint Commission estimated 80% of these cases were due to miscommunication (Neese, 2015). Pratt reflects on how in her years, she had to deal with plenty miscommunications regarding medications, especially when patients are discharged (C. Pratt, personal
Therefore, she may find it harder than most of the population to transition into the role of the patient and rely on others to make clinical judgements to promote and protect her recovery. Moreover, she was in a lot of physical pain, with her right leg in a full cast, causing her to be at bed rest. This I believe, as well as the patient being more aware of the inner workings of the hospital compared to other patients without a medical background, may of contributed to her ill ease and need to feel in control of her nursing care, over that of her care plan set by the
As new nursing graduates begin the process of transition into the nursing practice. There are many challenges and issues which are associated throughout the transition. New graduates may embark their journey through a graduate program or seek employment solo. The transition period may consist of challenges, that students will encounter during their journey. This essay will identify, discuss and critically reflect nursing key challenges that student nurses may face, throughout the process of the transition phase. The nursing key challenges chosen for this essay include professionalism, preparation, personal factors, competency factors, patient- centered care and job satisfaction. These nursing challenges will be thoroughly discussed and supported by current evidenced based research and nursing literature.
Sepsis is defined as a systemic inflammatory response caused by an infective process such as viral, bacterial or fungal (Holling, 2011). Assessment on a patient and starting treatment for sepsis is based on identifying several factors including the infective source, antibiotic administration and fluid replacement (Bailey, 2013). Because time is critical any delay in identifying patients with sepsis will have a negatively affect the patients’ outcome. Many studies have concluded every hour in delay of treatment mortality is increased by 7% (Bailey, 2013). Within this assignment I will briefly discuss the previous practice and the recent practice including the study based on sepsis. I will show what enabled practice to change and I will use the two comparisons of current practice and best practice.
we support our clients right to make their own decisions and secure their healthcare rights. Also informing them about the “speakup “ campaign in cases where they are being cared for in an unsafe manner. “Doing for” involves the nurse’s responsibility to do for the patients, what they would normally do for themselves but cannot do it at that time due to limited ability; either because they are in pain or disabled in any way as a result of their present illness, accident, or similar situations that results to, or is related to, activity impairment(s). Doing this helps them physically and emotionally. Meanwhile, it is important to maintain their dignity while doing things for them because their limitations can elevate their risk of emotional and psychological problems.
After the handover, I was asked by my mentor to attend to a patient who is bed ridden to have her personal care done with the assistance of one of the health care assistant staff. The patient was recently admitted to the ward and she looks sc...