assessment of an acutly ill patient

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Introduction

The aim of this assignment is to analyse a critical incident in the care of a patient with a severe life threatening illness. The writer will critically analyse the incident  and apply the appropriate research findings. Consideration will be given to the legal, ethical and profession issues surrounding the situation. The patient was a man in his early forties who will be referred to as John to maintain anonymity and confidentiality (Nursing and Midwifery Council: Code of Conduct 2004). The rational for this assignment is the writer experienced a valuable learning curve as to how patients can quickly present with complications and the importance of monitoring base line observations post operatively, as well as how open to infection this patient group are.  

Critical Incident

The writer was spending the day with the pain management team who consisted of, a pain nurse specialist and a senior house officer (SHO) from theatre. The patient was on a surgical ward and had a postoperative abdominal bleed, he had been rushed back to theatre were the bleeding had been stopped. The patient had a central venous pressure catheter (CVP line) insitu, which had become infected. The patient was in considerable pain his basic observations had been taken that morning, John’s blood pressure was low, pulse, respirations and temperature were all critically high and his oxygen saturation levels were below 90% on air.  

The doctor’s notes were unclear and the nurse managing Johns care did not understand what was meant regarding the CVP line. The nurse held a conversation with the Critical Care Outreach nurse and the Pain Specialist nurse and informed them she had not spoke with the doctor. The nurses interpretation of what the doctors notes were was to leave the CVP line in to enable medication to be given and this was of great concern to her because of it looking infected. In medicine were the stakes are high poorly formed handwriting can lead to unacceptable confusion and errors. Medical notes are a legal document and (Lyons, Payne, McCabe & Fielder1998) emphasise the importance of good note taking, as a court of law may take the line that if it is not in writing it has not been done. The nurse understood her obligation to the patient and requested the SHO on call to interpret the notes or clarify what should be done. However the Critical Care Outreach nurse made the decision to move the patient to the High Dependency Unit and all care would be taken over there.

The SHO immediately assessed John’s airway, breathing and circulation going on to assess the wound site and the infected CVP line. The European Resuscitation Council Guidelines (2005) state the effectiveness of breathing, the workload to the patient and the adequacy of ventilation can be achieved by the look listen and feel approach. Cole (2004) recognises a timely assessment and early recognition of potential problems is essential to ensure the optimal outcome for the patient. Ahern & Philpot (2002) echo and add observation of breathing determines adequate ventilations.

Respiratory rate is recognised and accepted as being the first basic observation in identifying patient deterioration (Goldhill, White & Sumner (1999).  Nursing staff recognised the deterioration of John and the potential for further deterioration. This was an essential critical element in his care, however this must be followed up by the appropriate response and correct intervention (Hinchliff, Norman & Schober 2003). Joe was commenced on oxygen therapy, which aided in the symptoms of breathlessness and low oxygen saturation levels. Administering oxygen reduces or corrects hypoxia by delivering a higher percentage to perfuse the tissues (Bennett, Makin & Bassett 2003).

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John continued to deteriorate and the SHO assessed his levels of responsiveness by asking his to open his eyes. Dougherty & Lister  (2004) advocate this process and advice to check the patient’s levels of consciousness by obtaining a response to verbal stimuli. John responded to voice by opening his eyes for a few seconds and looked straight ahead. John could answer when asked where he was which hospital he was in but was unable to speak in complete sentences. A motor response was gained by the SHO by pinching John’s ear lobe, he responded to this by moving his ...

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