Lily was a 65 year old lady with stage 5 CKD, she had recently begun hemodialysis treatment three times a week as an inpatient and had been responding well to treatment. During dialysis treatment on the morning of the first day, Lily’s observations showed that she was: tachycardic, hypotensive, tachypnoeaic, had an oxygen saturation level of 88% and was becoming confused and drowsy. It became apparent that Lily had become hypovolaemic. The hypovolaemic shock seen in this patient was of a particular critical nature due to the fact that her dialysis treatment had moved her rapidly through the first two stages of shock with her compensatory mechanisms failing very quickly (Tait, 2012). It was also much harder to identify the early signs of hypovolaemic shock, as some of the signs and symptoms could have been attributed to her kidney failure (Macintosh and Moore, 2011; Murphy and Byrne, 2009).
The time span of the nursing care provided for this patient will be over a two day period. This period of time focuses on not only the initial stage of the patient deteriorating, but will also cover the following 36 hour period of care where the patient was stable but still at a possible risk of deterioration. By covering this time period, this case study will have the opportunity to not only look into the psychosocial aspects of care provided, but also look into the clinical settings the care was provided in (acute/high dependency unit) and how this may have impacted on the care provided. In relation to Corbin and Strauss’s Trajectory model (1991) Lily was in the crisis stage of the eight stage model, this stage occurs when a potentially life threatening situation arises. This model is an interesting factor to consider in relation to the ps...
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...Royal College of Physicians. 2012. National Early Warning Score (NEWS). London: Royal College of Physicians.
Ryan, H., Cadman, C. and Hann, L. 2004. Setting standards for assessment of ward patients at risk of deterioration. British journal of nursing, 13 (20), pp. 1186-1190.
Samuelson, K. A. 2011. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients—findings from 250 interviews. Intensive and Critical Care Nursing, 27 (2), pp. 76-84.
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Tait, D. 2012. Acute and critical care in adult nursing. Los Angeles: SAGE/Learning Matters.
World Health Organisation. 2006. The World Health Report 2006 – Working together for health. Geneva: World Health Organisation.
Respiratory assessment is a significant aspect of nursing practice. According to the National Institute for Health and Care Excellence, respiratory rate is the best indicator of an ill patient and it is the first observation that will demonstrate a problem or deterioration in condition (Philip, Richardson, & Cohen, 2013). When a respiratory assessment performed effectively on a patient, it can result in upholding patient’s comfort and independence in progress of symptom management. Studies have acknowledged that in spite of the importance of the respiratory rate (RR) it is documented rarely than the other vital signs in the hospital settings (Parkes, 2011). This essay will highlight the importance of respiratory assessment and discuss why nurses
At the multidisciplinary meeting, the nurse will collect and assess the information provided by the other disciplines and family members stating that the patient is not at her prior level of functioning and then analyze the information to develop a diagnosis of deconditioning. Next, the nurse identifies outcomes for the patient to get stronger, achieve prior level of function, have activities of daily living (ADL’s) met in a safe environment by planning for home health, equipment, and 24/7 supervision through family or placement in a facility. This will be implemented by coordinating delivery of a walker and a 3 in 1 chair prior to discharge to daughter’s home with the home health agency nurse, physical therapist, and aide scheduled to start that day. In a week, the nurse evaluates that outcomes are being met by following up with patient, daughter, and home health agency evaluating that the patient is getting stronger, ADL’s are being met, and will soon be able to return to living independently. To achieve these standards of practice, every nurse should be aware of her own nurse practice act to ensure to be functioning with in the laws of the nurse’s state and to ensure the best outcomes and safety of the patients. In closing, it is every nurses duty to be the best nurse they are capable of being by looking at the scope of nursing practice which gives us the framework to achieve
Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010). Appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention, may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003). The 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' One of such early interventions may be offered by Roper, Logan, Tierney (1980) called the activities of daily living model.
An audit of patient records completed in 2005, revealed a low incidence of respiratory rate recording. An initial audit completed revealed that only 7% of 341 patients had a respiratory rate recording (Butler-Williams 2005). Due to this worrying outcome, the priority was to implement appropriate training to raise respiratory rate significance. Due to the audit being completed hospital wide and with no prior warning, it is an accurate indicator of an overall attitude of practice towards the recording of respiratory rate. Various studies have been conducted in order to gain an understanding as to why this precious sign is so often ignored. Jacqueline Hogan explored the paucity of patient monitoring on acute wards, completing qualitative research using focus groups in 2004. Four major themes were identified, firstly the issue of the nursing workload. Many participants acknowledged the expansion of the nurse’s role and with this added responsibility, the need for delegation of activities such as patient observations. Observations are often delegated to junior staff members such as healthcare assistants and student nurses. Although many nurses admitted to delegating this vital activity, 73% of nurses did not consider healthcare assistants possessed the required knowledge to interpret observational results. With this lack of knowledge comes the absence of appreciation for the completion of such vital signs, and
WEST, N and POPKESS-VAWTER, S (1994) The subjective and psychosocial nature of breathlessness. Journal of Advanced Nursing. 20 p622.
The nursing discipline embodies a whole range of skills and abilities that are aimed at maximizing one’s wellness by minimizing harm. As one of the most trusted professions, we literally are some’s last hope and last chance to thrive in life; however, in some cases we may be the last person they see on earth. Many individuals dream of slipping away in a peaceful death, but many others leave this world abruptly at unexpected times. I feel that is a crucial part to pay attention to individuals during their most critical and even for some their last moments and that is why I have peaked an interest in the critical care field. It is hard to care for someone who many others have given up on and how critical care nurses go above and beyond the call
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
(3)Bellomo,R.,Cass,A.,Cole,L.,Finer,S.,Gallagher,M.,Lo,S.,McAthur,C.,McGuinness,S.,Myburgham J.,Norton,R.,Scheinkestel,C.,& Su,S. for renal study investigators(2009).Intensity of continuous renal-replacement therapy in critically ill patients. The New England Journal of Medicine, 361(17), 1627-1638.
Traditionally nurse’s role in evaluating a patient has to record the observations made but not to interpret them. The main observation includes pulse, temperature, rate of respiratory, blood pressure and consciousness level (Alice, 1985). The ability of nurse to record such observations accurately will determine the priority of the patient care. Assessment based on priority setting is one of the major skills that nurses that are newly fit may lack. Th...
The nursing process is one of the most fundamental yet crucial aspects of the nursing profession. It guides patient care in a manner that creates an effective, safe, and health promoting process. The purpose and focus of this assessment paper is to detail the core aspects of the nursing process and creating nursing diagnoses for patients in a formal paper. The nursing process allows nurses to identify a patient’s health status, their current health problems, and also identify any potential health risks the patient may have. The nursing process is a broad assessment tool that can be applied to every patient but results in an individualized care plan tailored to the most important needs of the patient. The nurse can then implement this outcome oriented care plan and then evaluate and modify it to fit the patient’s progress (Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P., 2011). The nursing process prioritizes care, creates safety checks so that essential assessments are not missing, and creates an organized routine, allowing nurses to be both efficient and responsible.
-World Health Organization. 2013. Chronic disease. Available at: http://www. who.int/topics/chronic diseases/en/. Access date 1 December 2013.
...based medicine: what it is and what it isn't. British Medical Journal. 312:71 [online] Last accessed on 13th February 2014. [Available at:] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2349778/pdf/bmj00524-0009.pdf
Nurses want to give complete and quality care, but are unable to, due to the constant needs of their workload and inadequate staffing. They have to prioritize their patients needs based on the most critical treatments first. Then whatever time is left, they fill in what treatments they can. Some reasons that nursing treatments are missed include: too few staff, time required for the nursing intervention, poor use of existing staff resources and ineffective delegation.” (Kalisch, 2006) Many nurses become emotionally stressed and unsatisfied with their jobs. (Halm et al., 2005; Kalisch,
...ully aware of what the procedure involves and the possible risks and complications. I feel that the pre-assessment form used within the unit to be far to fundamental, If elements of the roper et al activities of daily living were to be incorporated this would help in achieving a much more in-depth holistic nursing assessment enabling for the best quality and level of care to be given to all patients arriving in the unit. Whilst I feel a full nursing assessment not to be fully necessary for a day case unit, as previously stated I feel that the communication element to be an excellent way of ensuring a better holistic approach is achieved, it will also help to achieve better documentation and communication between all staff members. Good documentation remains in line with the NMC code of professional conduct 2008 and to promote better communication (NMC 2008).
When a nurse is providing patient care, he/she creates a safe environment for the patient and enables the choice to establish a relationship on a human to human interaction or on a transpersonal level. The patient will be acknowledged as a person with the wholeness of their soul despite their illness or number on the bed. The ten carative factors in this theory are used as an education tool for nurses around the world and should be applied to the different care situations in practice. Nurses use the factors to promote growth in themselves and within the patient. A nurse should respect the patient’s decisions and take the time to fully be present in the moments with the patient. A lot of nurses complain about the time limitations they have and do not provide the necessary amount of time to listen and gather the patient’s perspective of the situation. Another way this theory can be applied to practice is by recognizing the caring moment between you and the patient. This will determine how the relationship will