Effects on oxygenation, comfort, and clinical outcome.

There is a natural phenomenon that explains effective medical care as per Douw et al. (2015) explanation; the phenomenon is, patient recovery is considered a direct effect of medical treatment and care implemented for the particular patient. As per this phenomenon, the medical procedures are designed, diverted, manipulated and transformed to get effective patient outcomes (Ignatavicius & Workman, 2015). Nursing care is a very important part of any medical procedure to get an effective patient outcome. The nurses’ function in almost all zones of medical procedures from acute care, ambulatory care, critical care, developmental care, emergency care, admission care to surgical care. Hence, nursing care is the most diversified and important part of medical procedures to induce effective medical care (Smith, Duell & Martin, 2014).

The nursing professionals need to implement care procedure as per patient condition by implementing their practical understanding along with their theoretical knowledge. A nursing professional need to assess, diagnoses, plans, implement and evaluate care process ‘on the spot’ as per their patient situation and requirement  (Dunphy, Winland-Brown, Porter & Thomas, 2015). The present study in context to case study patient Mrs. Frank explores a detailed nursing process that is executed specifically as per patient (Mrs. Frank) condition and requirement using both practical understanding as well as theoretical knowledge.

In the theoretical database of nursing care, the primary assessment allows identifying any life-threatening or serious health hazard occurring with the patient in an emergency or critical situation. But, a nursing professional has to implement their potential practical understanding to perform a primary assessment on the patient as per their present situation  (Hamer & Collinson, 2014). In the present case, working as a general surgical ward nurse Mrs. Frank database was received in the early hours where She was found in the critical situation around 0730. She was observed clutching her chest tightly due to the feeling of tightness in chest and she also mentioned about her difficulty in breathing. These are her observed emergency conditions. According to Douw et al. (2015) studies, the department nurses are responsible for the acute assessment of the patients suffering emergency trauma or medical difficulty. The use of ABCDE and DRS are the most common technique employed to the regular primary assessment of emergency patients. Therefore, both of these primary assessment techniques are suitable for performing a primary assessment of Mrs. Frank as per her emergency situation and handover data provided to surgical nurse.

Airway: The identification of airway obstruction is a must to ensure the absence of hypoxia leading to the danger of death  (Considine & Currey, 2015). In the present situation, Mrs Frank was found sitting straight with no such position showing airway obstruction.

Breathing: The patient indicates the difficulty of breathe in her present situation. This situation highlights respiratory distress  (Munro et al., 2016).

Circulation: Mrs Frank is experiencing chest pain indicating circulator disturbance or disorder (Rubenstein et al., 2014).

Disability: Mrs Frank was perfectly sitting in proper position as well as she was alert about her condition but as per her handover situation, she finds it difficult to walk without support (walking stick) and has not mobilised much after her surgery. Therefore, secondary assessment is essential to determine the occurrence of any disability  (Smolowitz et al., 2015).

Exposure: There was no sign or indication of any exposure while entering the room. Therefore, exposure can be considered negligible in this condition.

Danger: Mrs Franks had a history of anxiety and depressive episode. Therefore, this situation indicates a danger of a similar episode of anxiety or depression. Otherwise, the danger is negligible.

Response: Mrs Frank properly responded about her condition as a nurse entered the room where she clearly indicated difficulty in breathe.

Send for help: In the present situation, Mrs. Frank surely needs further assistance to determine the risk behind her signs of clinical deterioration (Considine & Currey, 2015).

After completion of the primary assessment, the next process is to look forward on focussed assessment based on the present situation of patient Mrs. Frank. The very first priority, in this case, is to assess the Cardiovascular System of Mrs Frank as she is found in a doubtful condition of clutching her chest tightly that indicates clear intuition of cardiovascular event. Adding on to this, as per handover information, Mrs. Frank is having a history of heart failure and taking medication for similar. Further, she is complaining tightness in the chest that can be considered a critical sign of cardiovascular malfunction requiring immediate action (Forsberg, Ziegert, Hult & Fors, 2014). The first priority question should be asked regarding cardiovascular assessment is ‘Have you felt this kind of chest pain before?’. This question helps to analyse or predict the similarity between her present condition and her previous heart attack condition. Asking this question assist in determining the cause of chest pain whether it is multisystemic or cardiac in origin (Morley et al., 2014). The second priority question for Mrs. Frank is ‘Do you have any family history or heart attack or any other cardiovascular disease?’ this question helps to analyse the genetic linkage for cardiovascular disease that can help to predict risk factor associated with her chest pain (Lewis et al. 2016). As a professional performing cardiovascular assessment, it is essential to attain patient consent, as this assessment process needs chest exposure. Mrs. Frank should be placed in a proper sitting position to ensure satisfactory breathing after which her thorax color, face, abdomen, nails and mucous membranes should be examined properly. Further, identify S1 and S2 heart sounds and PQRST assessment to detect the cause of chest pain (Urden, Stacy & Lough, 2015).

Individuals with acute medical conditions

The next priority is to analyse the Respiratory System of Mrs. Frank as she is complaining about difficulty in the breathe. Although her respiratory rate is reported to be normal in handover assessment, however, as she is suffering asthma and her oxygen saturation result is 92% which is a bit lower than normal indicates a requirement of respiratory assessment (Forbes & Watt, 2015). According to Forsberg et al. (2014) studies, the patient having a history of asthma, develop heart failure and difficulty in breathe clearly indicate the development of chronic obstructive pulmonary disease (COPD) which is a condition requiring immediate attention. Therefore, respiratory system assessment is a priority in the case of Mrs. Frank because she is having a history of asthma and heart failure complaining about difficult breathe. The first question for Mrs. Frank related to respiratory assessment is ‘Do you recently have an episode of the asthma attack or respiratory illness?’, as she is having a history of asthma this question will help to predict the seriousness of the condition. According to Forsberg et al. (2014) studies, regular episodes of asthmatic attacks after any surgery may be an indication of pulmonary embolism or COPD (Morley et al., 2014). ‘Have you taken your prescribed medications as scheduled?’, this question will help to predict any kind of onset related to COPD because if the patient has taken medicine for asthma then difficult breathe should not occur. Such situations of unexpected chest pain indicate the onset of COPD (Urden et al., 2015). For respiratory system assessment, Mrs. Frank should be placed in a 45-degree angle position followed by obtaining her consent for back and chest exposure. Inspection involves testing her chest, respiration rate, chest wall movement and normal functioning of accessory muscle (Lewis et al. 2016). The chest wall expansion and symmetry are tested using palpate followed by testing lungs area using percussion. Lastly, normal breathing sounds, crackles, rhonchi, wheezes, vocal resonance, adventitious sounds and pleural friction rubs are tested in respiratory assessment (Morley et al., 2014).

The third priority is to assess the normal functionality of the patient’s Neurological System because she is having a history of depression and anxiety episodes as well as she is on medications to handle her neurological disturbance. Munro et al. (2016) indicated that people suffering neurological disturbance generally suffer from critical neurological malfunction after any major surgery or critical medical process because they are not able to handle the stress and trauma of such situations. Therefore, it is important to analyse the normal functioning of Mrs. Frank neurological system. The first priority question asked to Mrs. Frank is ‘Do you recently have an episode of depression or anxiety?’ because she is having a persistent history of depression and anxiety this question helps to detect the link between her present condition and her existing neurological disorder.

Ensuring a proactive, evidence-based, patient safety approach to patient assessment.

According to Forsberg et al. (2014) studies, neurological assessment is essential for patients undergoing any major surgery because trauma due to surgery can trigger a malfunction in the nervous system creating episodes of neurological disorder. Further, scientifically explaining that disturbance in the musculoskeletal system and neurological system interconnection due to surgical process generally triggers disturbance in nervous system function. The next priority question related to neurological system assessment is ‘Have you recently undergone any change in your scheduled medication brand or dosage?’, As Mrs. Frank is taking a lot of medicines to control her diseases any kind of change in medicine or dosage can trigger neurological disturbance (Lewis et al. 2016). As Mrs. Frank is very anxious about her husband condition who is suffering Alzheimer’s disease, it is possible that her tension would have triggered her anxiety causing hyperventilation symptoms of anxiety that involves chest pain, restlessness, panic attacks and nervousness (Morley et al., 2014). For neurological assessment, it is essential to gain Mrs. Frank’s consent followed by letting her understand the protocol of neurological examination. According to Munro et al. (2016) studies, a Mental State Examination (MSE) is the appropriate tool to examine patient having a history of depression and anxiety. Therefore, MSE is used to determine Mrs. Frank’s level of mental status in the present situation. The MSE assessment shall be enough for Mrs. Frank as per her condition.

After performing the primary and priority assessment of Mrs. Frank present condition, her medical history and clinical handover details some of the health problems are identified to be concerning in her case. As per these findings, the physiological deterioration can be due to her history of heart failure and asthma keeping her at the risk of cardiac or respiratory risk. Further, her psychological state of mind concerning her husband can also contribute to her physiological distress. Further, Mrs. Frank is a victim of depression and anxiety indicating it as a major cause of deterioration.

Chest pain is one of the main identified health problem faced by Mrs. Frank as she was complaining about it at 0730 clutching her chest tightly complaining about tightness in the chest. However, the timing of medication and onset of chest pain is not known but it can be assumed that oxycodone provided in the night may have been ineffective to control her pain. In the night duty assessment, the nurse reported that Mrs. Frank was restless and didn’t sleep much at night. This means may be she is facing chest pain issue at night aswell. Therefore, chest pain is the most important health concern to deal with in the present situation of Mrs. Frank. Further, Mrs Frank has not mobilised much after her surgery. She was using the walking stick to walk before surgery and now showing no motion due to pain. Therefore, pain management is a severe requirement in her condition (Rogers & Bush, 2015).

Primary Assessment Techniques in Emergency Situations

Further, Mrs. Frank complained about the difficulty in breathing at 0730. This is another priority health concern for Mrs. Frank requiring prioritisation because she is already a victim of asthma and heart failure. The patient feeling difficulty in breathing indicates a medical emergency situation that requires immediate attention by comforting her with breathing interventions (Daskalopoulou et al., 2015). Lastly, mental distress is another health concern for Mrs. Franks. She is continuously worried about her husband condition at home as he is suffering from Alzheimer’s disease, further, she is also a victim of depression and anxiety. Her present condition can also be considered as the outcome of her mental distress. Therefore, it is essential to manage her mental distress as a priority concern (Fortinash & Worret, 2014). Coming on to the potential health problems diagnosed in provided case, Mrs. Frank persist potential problem to undergo another heart failure because she is observed with chest tightness, restlessness and pain after surgery. Lastly, her additional potential problem is her emotional imbalance of being lonely and due to her concern about her suffering ill husband.

After completion of nursing assessment and diagnosis, the next step is to provide nursing interventions. In this section the process for proper nursing interventions planning, implementation and evaluation are provided as per identified health problems in case of Mrs. Frank.

Mrs. Frank clearly states her medical situation of unbearable chest tightness. As per clinical handover, she was the restless previous night before confronting chest tightness and didn’t sleep well. As identified in diagnosis this chest pain can risk cardiac or respiratory criticalness. Therefore, pain management is the first most important intervention for Mrs. Frank. As per her condition, the pain management intervention studied by Dean (2014) would be most suitable. The very first step for managing Mrs. Frank pain is by assessing her vital signs. These vital signs are affected if the pain is serious and they help to detect the reason of pain. Further, chest pain does not occur after the administration of oxycodone. Therefore, stronger analgesia can be recommended for administration by professional to control pain (Mebazaa et al., 2015). Further, Mrs. Frank is not able to mobilise due to pain in her surgery area as mentioned in the handover. The very first requirement is to perform the assessment about the location, characteristics and quality of her pain. If possible non-pharmaceutical care processes shall be implemented like massage, breathing techniques, medication etc. under professional guidance for surgical site pain. This pain management intervention can be evaluated by documenting the patient’s response to pain management process. This will help to further understand and modify the impact of pain management intervention (Foy, Liu, Davidson, Sciamanna & Leslie, 2015).

Cardiovascular System Assessment

Mrs. Franks is identified with difficulty in breathing and low oxygen saturation rate making it necessary to implement oxygen therapy in her case. However, her oxygen saturation is not very low, therefore, nasal prongs would work to provide the necessary oxygen flow and it should be implemented properly (Maggiore et al., 2014). If Mrs. Frank is observed in the comfortable state with satisfactory breathing this intervention can be considered effective. Further, to evaluate the effectiveness of oxygen therapy, the oxygen saturation rate can be determined that ensures increased oxygen saturation (Lemiale et al., 2015).

In Mrs. Frank case there are identified variables that place her at a risk of fall, this includes her age, surgical site (lower abdomen), pain in locomotion, breathing difficulty and presence of stoma site. However, she has not suffered any such fall incidence but positioning would help to avoid fall, easier breathing as well as improve her locomotors pain (Kovacs, Avian, Pienn, Naeije & Olschewski, 2014). The most appropriate position, in this case, is semi-fowlers or fowlers position (Higginson et al. 2014). If Mrs. Frank were placed in this position she would experience comfort in breathing further minimizing her risk of fall due to pain. Identifying the respiration rate of Mrs. Frank can test the impact of positioning intervention.

In the first place, Mrs. Frank underwent an open hemicolectomy surgery that has a temporary stoma site. It is reported that Mrs. Frank is not confident to care for her surgical site. Therefore, surgical site care intervention is essential for better recovery. The surgical site should be taken care and patient should be guided about this care intervention for future management of the surgical site. For stoma site care step involves washing kin with warm water, drying it, attaching pouch carefully, avoiding skin care products and no use of oil products or alcohol cosmetics (Baykara et al. 2014). Proper wound healing without infection or damage indicates effective intervention.

There is identified respiratory risk in the case of Mrs. Frank predicted by her present situation of difficulty in breathing as well as her history of asthma. Therefore, she needs proper care for her breathing difficulties. According to Thomas & Bruton (2014) studies, five most effective breathing exercises are deep breathing, huff cough, pursed-lip breathing, coordinated breathing and diaphragmatic breathing. Any of these breathing exercises should be implemented as a breathing exercise as per the consent and comfort of the Patient. One can evaluate the effectiveness of breathing exercises by getting the patient response of comfort and easiness in breathe.

Respiratory System Assessment

Mrs. Frank is suffering mental health issues of depression and anxiety; further, she is dealing with emotional distress due to her concern about her husband condition at home. As per her present situation, it is not logical and suitable for her recovery process to handle this mental stress. Therefore, professional counselling is a must to overcome her emotional distress for better recovery. According to Ruckert (2015) studies any kind of control over anxiety, restlessness and confusion in the patient response indicates a positive mental health status developed by counselling. Therefore, by evaluating control over anxiety, confusion and restlessness of Mrs. Frank situation indicates a positive impact of mental health counselling.

This intervention would work to control depression and anxiety in the case of Mrs. Frank. According to Hallgren et al. (2015) studies, cognitive behavioural therapy for depression and anxiety involves positive reframing, decatastrophizing, encouraging communication and assertiveness training. The positive reframing involves the conversion of negative thoughts to positive. Decatatrophizing involves the use of a questionnaire to develop a more realistic viewpoint about the trauma. Encouraging communication helps to talk about traumatic experiences and assertiveness training helps patient to get a control over the negative situation. The cognitive behavioural therapy is reported to reduce the relapse rate by 40% globally (Landa et al., 2016). A positive patient response to therapy ensures that cognitive behavioural therapy is effective.

As Mrs. Frank and her husband both are facing medical health issues, therefore, it is essential to implement a discharge care management plan for a comfortable and stable living after returning home. This involves replacing dangerous households with anti-slip household instruments, handrails, walking support etc. (Jurgens et al. 2015). Further, occupational therapist and rehabilitation can also help to ensure safety measures at home for both the patients (Fortinash & Worret, 2014). The positive outcome of discharge care management can be evaluated as per response documented by the occupational therapist.

Conclusion

The nursing care is the most important part of the medical treatment process as explained in this clinical case study. The primary assessment is essential to determine the emergency requirement of care. Further, nursing diagnosis helps to quickly detect the possible and potential health issues with the patient followed by nursing interventions that help to control the patient situation.

In the provided clinical case study, Mrs. Frank underwent a surgical process in the hospital and developed certain critical symptoms that are either related to her surgery or her medical history. By implementing primary assessment her clinical disturbance health disorders are identified which are further managed using effective nursing intervention. The assessment, diagnosis and treatment are tailored and structured as per case study patient need to ensure proper nursing care.

Neurological System Assessment

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