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- Subject Code : NSB236
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- Subject Name : Nursing
Integrated Nursing Practice
Introduction to Deteriorating Patient Care
A deteriorating patient is defined as an individual who transcends from one clinical state to another increasing their risk of morbidity and organ dysfunction (Wright et al., 2019). This essay will focus on a critical case study of a 66-year-old patient, Charles Nobother who has been admitted in the care facility after a motor vehicle accident. The patient has suffered from multiple fractures and has clinically deteriorating health with poor maintenance of vitals with significant impacts of trauma. The health condition of the patient is unstable postoperative to the orthopedic management of fractures. This essay will focus on the identification of the cause of deterioration in Charles using the National Safety and Quality Health guidelines with an evidence-based approach. Further, this essay will also identify the two priority signs and symptoms that require immediate management and associate them with the pathophysiology of the patient. Moreover, the application of suitable interventions for the management and care of Charles will also be discussed in this essay.
National Safety and Quality Health Guidelines
The National Safety and Quality Health guidelines for a response towards a deteriorating patient identifies the eight factors that are associated with the clinical deterioration of the patient (Moran et al., 2016). These factors include poor monitoring of physiological observations of the patient and poor understanding of the changes in the physiological observations of the patient. Factors that also contribute to deterioration are knowledge deficit of signs and symptoms that signal deterioration (Richards et al., 2017). The other factors are limited awareness regarding the potential mental state of the patient, knowledge deficit of delirium, formal systems for deterioration response, and skills to manage the deteriorating patients. Failure to communicate and attribution of existing problems to current health problems have been identified as the key factors responsible for the deterioration of health of the patients. In the given case scenario, the primary factor that led to the deterioration of the health of Charles was a poor understanding of the changes in the physiological observations of the patient. Healy (2016) argue that in cases with multiple health complexities, like that of Charles, it is often difficult to attribute the signs and symptoms and the patient vitals to particular pathophysiology. And thereby, multiple clinical assessments are conducted to reach a differential diagnosis (Richards et al., 2017). However, error in observations and crucial monitoring of the patient vitals can result in a lack of acknowledgement of the primary signs that are responsible for the deterioration of the patient health (Moran et al., 2016). Factors that may result in failure to recognize or respond to clinical deterioration include a critical assessment of the patient vitals and all the potential health dangers that are possible in the clinical scenario (Healy, 2016). In major motor vehicle accidents like that of Charles, it is suited that a complete scan of the patient is undertaken using tomography or other screening techniques to underpin the cause of health deterioration. To reduce the incidences of deterioration in the patients and limit the failures to recognize and respond to clinical deterioration in the patients, it is suggested a multidisciplinary assessment team is appointed to perform differential diagnosis for the health of the patient to achieve a conclusive analysis (Fortnum & Bradshaw, 2019). It is also suggested that patient is monitored effectively at all the stages and the observations and results are regularly monitored to update with the patient response to mitigate a successful intervention and stop further deterioration of the patient health (Fortnum & Bradshaw, 2019).
Signs, Symptoms, and Pathophysiology
The two critical signs of clinical deterioration of the patient are the respiratory rate of 33 breaths per minute and oxygen saturation of 92% with supplementation of 4L oxygen with nasal prongs. the second critical sign of the clinical deterioration of the patient is the presence of brown urine and poor fluid balance in the body of the patient. The patient had initially presented with shortness of breath and with reluctance to deep breathing at 14:00 hours. The patient was later diagnosed with acute kidney injury. This can be attributed to the blunt trauma faced by the patient after the motor vehicle accident. Shortness of breath in this condition is caused by two primary reasons. The extra fluid in the body after the injury builds up in the lungs and results in difficulty in breathing in the patient (Vanmassenhove et al., 2018). Further, anemia is caused in the patient, also indicated in blood tests with a Hemoglobin count of 74g/L against the normal count of 130g/L (Moore et al., 2018). This can leave the body starved of oxygen and thus increase the respiratory rate of the patient. The respiratory rate is considered as one of the initial signs of clinical deterioration and is thus of prime importance signalling poor clinical health of the patient in the facility (Vanmassenhove et al., 2017). A primary sign for acute kidney injury is the poor fluid balance in the patient as kidney primarily function to regulate the fluid balance of the body. The urine output of the patient is abnormal with 18mL/per hour against the normal release of 1.5-2mL/kg/hour. As the kidney is damaged, the kidneys fail to function properly and result in fluid imbalance resulting in swellings. The kidney injury is also indicated by the poor electrolyte balance of the patient and presence of brown urine indicating presence blood with an extremely high serum creatinine of 136 micromoles per Liter against the normal range of 32-82 micromoles per Liter.
Priority Problem and Interventions
Identification of the primary priority problem is crucial for health management and limiting the clinical deterioration of the patient. Charles health condition is complex and deteriorating rapidly. The patient has unstable vitals with poor electrolyte balance and determines signs of acute renal failure. The patient has also suffered from multiple fractures and is under extreme pain at a pain index of 8/10. The primary priority that must be addressed to limit the deterioration of the health condition of the patient will be to manage the acute kidney injury of the patient. The management of the acute renal injury of the patient has been identified as the primary priority problem for the following reasons: First, management of the acute renal injury will help in the management of the patient vitals (McNicholas et al., 2019). That is, it will help in the stabilization of the respiratory rate of the patient, prevent spread of trauma and organ failure. Secondly, it will also help in the stabilization of the electrolyte balance of the patient and prevent shock (Panitchote et al., 2019). Thus, management of acute kidney injury will prevent further deterioration of the health of the patient and prevent further complications. A second priority should be given to pain management of the patient (McNicholas et al., 2019). Regarding the management of acute renal injury diagnosed in Charles, the first suitable intervention is to ensure hemodialysis. Hemodialysis is a collaborative intervention that requires assistance from a specialized team. Dialysis is a suitable intervention for the care of Charles as it will relieve the stress from the renal system of the patient through artificial purification of the blood and ensure improvement in the health of the patient by stabilization of the vitals (Perner et al., 2017). Intermittent hemodialysis will also be beneficial as it will help in the management of Uremia and prevent immediate death that may occur from the complications of renal failure. Availability of the dialysis apparatus will ensure that the kidney fiction is replaced until their recovery. This will also allow the healthcare professionals to mitigate a response for secondary complications experienced by the patient as well and thus ensure holistic care (Perner et al., 2017). The efficacy of the applied intervention can be assessed through the visible improvements in the patient vitals and normalization of the health condition of the patient. The fluid balance and retention will also regularise in the patient after the proper initiation of hemodialysis (McNicholas et al., 2019). Along with these short term recovery signs, long term efficacy of this intervention can be seen by the recovery of the kidneys of the patient and restoration of function without the need of supplementary apparatus (Circcia & Devarajan, 2017). Second intervention that is pharmacological in nature can also be applied for the management of acute kidney injury of the patient. This intervention is the administration of endothelin inhibitor medications. Endothelin inhibitors is a potent vasoconstriction peptide. The medication is also used for renal disorders and acute ischemic renal failure. The efficacy of this intervention can be assessed by checking the improvement in renal recovery (Mehta et al., 2016). Along with this, nursing intervention for the management of the health condition Charles will be IV administration of the isotonic sodium chloride solution. This will help in the management of the fluid balance of the patient (Arora et al., 2020). The assessment of this intervention and efficacy can be assessed with the observation and monitoring of the fluid balance of the patient (Shen et al., 2018).
Conclusion on Deteriorating Patient Care
This document provides a critical analysis of a case study of patient, Charles Nobother who has suffered from critical injuries after a motor vehicle accident. This essay identifies the cause of clinical deterioration using the National Safety and Quality Health guidelines. The factor responsible for the clinical deterioration and identifies the cause of failure in response and recognition of the deterioration. This essay also identifies ways to reduce the incidences of mismanagement of deterioration in patients with an evidence-based approach. Based on the case study, this document identifies to the two priority signs and symptoms, That is, abnormality in the respiratory rate and the fluid balance of the patient. A priority problem is identified for management of the health of Charles, that is, management of the Acute kindly injury of the patient. To limit the further deterioration two clinical interventions have also been identified in this study. A collaborative intervention to provide the patient with hemodialysis to manage the acute kidney injury and pharmacological intervention of the administration of endothelin inhibitors have been suggested in this assessment for the overall management of the condition of the patient.
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