NSG3RDP: Recognizing and Responding to the Deteriorating Patient Assessment Answer

Ans 1:

Rosie Jones is a 5- year old female and the social history suggests the patient lives in Numurkah. The child has been brought to the emergency department by her mother. It has been observed that the child was not as cheerful as she usually is. The child was unable to breathe adequately, the oxygen saturation recorded is below 92%, and the dose of salbutamol via a spacer is 3 doses every 20 minutes(Toney-Butler & Unison-Pace, 2022). As the breathing pattern is affected, it is necessary to maintain it. The patient should be observed every half an hour. The major reason for the shift of the condition is that the infant is unable to breathe adequately. The breathing pattern needs to be maintained, to carry out daily life functions adequately. An audible wheezing sound is heard and this needs to be controlled. There is an increase in the respiratory effort also, all these signs and symptoms need to be noted and progress towards the treatment should be made. If the respiratory condition is not treated adequately or timely it will have a deep and negative impact on health. After maintaining the respiratory rate other body functions will occur adequately. The medication of the patient is carried adequately, this will ensure the medical condition is maintained (Toney-Butler & Unison-Pace, 2022). If the baby's lungs are not fully developed then the respiratory process will be impacted. As the respiratory status is impacted the other body functions will also be affected, hence, it needs to be cured immediately. If the baby is born with some breathing problems then they will be attached to some breathing machine or also known as a ventilator. This machine is helpful because it will provide support for the breathing problem. There are several reasons which can be present so the babies have irregular breathing problems, some of these are described below. One of the major causes is that the infant is sleeping deeply. Since the sleep is so deep it interferes with the breathing pattern (Kinyon et al., 2021).

One of the major reasons for changing the condition of the baby is that the oxygen supply which is received by the baby is inadequate. Low levels of oxygen in the body affect several other symptoms. Since the oxygen concentration is so low, hourly observation of the patient should be made, this will help to keep a track record of the oxygen which is present. Along with it, the oxygen level is maintained, and since its level is maintained all the body functions are carried adequately. There are several abnormalities observed in the breathing pattern and these are mentioned below. Apnea, orthopnea, hyperpnea, hyperventilation, hyperventilation, Cheyne-Stokes respiration, hypoventilation, and Kussmaul respiration (Fontenot et al., 2022). There are majorly 3 problems which are associated with breathing and these are lung problems, obstructive pulmonary disease (COPD), and heart disease. The infection in the airway needs to be treated otherwise it will create problems with breathing. When the baby breathes several changes occur such as changes in body temperature, some changes in the liver, and gastrointestinal changes. Other than this urinary system, the immune system, and even the skin is affected. There are several signs of respiratory distress and some of these are mentioned below. If the child is unable to breathe effectively then he needs an intensive care unit so breathing can be restored easily. Some signs of respiratory distress are mentioned below: weak crying, grunting, tracheal tug, subcostal or intercostal recession, or sternal recession (Zemaitis et al., 2022).

The children is more likely to be infected from ear infection, and if not treated timely it can future lead to infection. Physiotherapy can be provided to the patient, this will help in maintaining the breathing style. However, when the patient is an infant, physiotherapy becomes difficult, but some methods can be adopted. Some manual techniques can be adopted like percussion and vibration. Postural drainage is also an effective method and it should be adopted. When an infant is concerned then several pieces of equipment can be used which will assist in respiratory care, this is effective care. In the newborn baby if breathing is not restored then it severely affects the developing brain. If the brain development is affected then it will also affect the development of other body parts, hence, the health of the brain is highly effective. In several cases, it has been observed that if timely treatment is not provided to the child then it will also result in some cardiovascular problems. Cardiovascular problems directly impact the health of the heart (Huber & Epp, 2022).

Ans:2 

The ABCDE assessment stands for Airway, Breathing, Circulation, Disability, and Exposure. It is a systematic approach and it is required in the immediate assessment along with treatment of critically ill or injured patients. This assessment is highly useful and it is widely applicable in all clinical emergencies. The major advantage of this approach is that it can be used in the street without any equipment, there is no advanced form of equipment being used. Some aims of the ABCDE approach are described below. It helps in providing life-saving treatment, in certain cases it helps to break down some complex clinical situations into more manageable parts (Linders et al., 2021). In addition to it, it serves as a treatment and assessment tool, it establishes situational awareness for all the treatment providers. Other than this, it helps to buy time to establish treatment and diagnosis. There is some evidence that suggests that the ABCDE approach is adopted to treat critically ill or injured patients. This approach has been widely used and accepted by emergency technicians, traumatologists, and critical care specialists. To adopt this approach healthcare professionals must be trained to use this. It helps to build confidence and several concerns are easily addressed (Peran et al., 2020). The most important thing to take into consideration is that healthcare professionals need to be trained appropriately so changes can be made effectively. Other than this it is also essential to determine which assessment technique is highly useful and which requires a small amount of changes. When the respiratory status of the patient is assessed, then one important thing to note down is that it affects other body parts also. In that situation, this assessment technique should be followed as it will help to provide an overview of the condition. Breathing is not only important for the respiratory system but it is also highly important for the maintenance of the other body parts. Hence, it is recommended that it should be done carefully, and all the steps should be adopted carefully.

The other assessment which is adopted is the head-to-toe assessment, it is a comprehensive physical assessment data and this collection method gathers the patient data and determines the health status of the patient. In this examination method, the entire body from head to toe is studied as a systematic matter. All the health issues of the patient have been identified, hence, it needs to be studied appropriately. It assists the nurse to better understand the patient's status. In addition to it, it will also help you to understand the patient's needs. The assessment is such that it encompasses every body system and the patient's neurological and mental needs (Huber & Epp, 2022). Several assessment techniques need to be followed while carrying out head-to-toe assessment and these are: inspection, in which the different sense of smell, vision, and hearing is important and any abnormal findings need to be reported. Other assessment techniques require palpitation, in which parts of the hands touch and feel need to be tested, percussion is also an important test, in which different body parts are tested and they produce sound waves. The last test which is carried out is auscultation, in this stethoscope is used to listen to the heart sound and other movements which are carried in the body. All these assessment techniques need to be followed and it should be studied adequately. Both of these assessments are different and they perform differently, both these assessment techniques carry different sets of activities and both these assessments are required to study the patient's condition and work adequately. In the case study, it has been mentioned that although the patient has been diagnosed with breathing problems, these assessments will help determine how effective this technique is and how it will help treat this condition. The major assessment which is required is the respiratory status assessment, the respiratory health of the patient needs to be assessed and it should be worked on. Often, assistance will be required from emergency medical services, a specialist, or a hospital response team (eg, medical emergency team or cardiac arrest team). The ABCDE approach helps to rapidly recognize the need for assistance. Responders should call for help as soon as possible and exploit the resources of all persons present to increase the speed of both assessment and treatment. Improved outcome is most often based on a team effort. On completion of the initial ABCDE assessment, assessments should be repeated until the patient is stable. It must be remembered that it may take a few minutes before the effect of an intervention is evident. In case of deterioration, reassessment should be performed.

Ans 3.

The respiratory rate (RR) or the number of breaths per minute is a vital source that represents ventilation also known as the movement of air in and out of the lungs. When the RR is changed, it is usually the representation of deterioration, and the body attempts to maintain oxygen delivery to the tissue. Other than this in the respiratory system, several other factors affect the RR these are stressors, some cognitive load, cold, heat, exercise-induced fatigue, and physical effort. When abnormal breathing occurs the body needs to be adjusted towards low oxygen or high carbon dioxide levels (HErbert et al., 2020). There is abnormal breathing which is caused by the body and it is needed to adjust to low oxygen or even high carbon dioxide levels. If these levels are not maintained nicely then it will lead to several changes in the body such as breathing patterns might be impacted and it displays several problems. Since the condition of the patient is deteriorating it is highly critical and it leads to early detection, competence, and timeliness. All the staff members who are engaged in the care of the patient should be present in the hospital and also prehospital assessment of the patient is required. Maintenance of breathing patterns is highly necessary, this ensures that all the work is done in adequate time and effective steps need to be taken (Barbi et al., 2017). Several steps need to be adopted to ensure that breathing rate is maintained hence, effective steps need to be followed. If the respiratory rate is not maintained it will impact the other body parts because adequate oxygen is not present to other body parts, hence, the body functioning is affected and the care process is impacted (Sakai-Bizmark et al., 2019).

Maintenance of respiratory rate is not only important but other than this, it should only be done accurately and reliably. If the tests are not performed accurately and reliably then it will impact the testing procedure, and how the test details are represented. It is highly important to sit down, relax and take deep breaths. The breathing rate should be checked by counting the number of times the chest and abdomen rise in one minute, this number should be recorded. The best way which is present to measure the respiratory rate (RR) is to count the breaths using a timer for 60 seconds (Sapra et al., 2023). This will help to provide an overview as to what is the breathing rate and how it should be measured and monitored. However, in the case study since the patient is a pediatric patient, other techniques are used, these are nasal thermistors or also known as nasal cannula flow/ pressure, and respiratory inductance plethysmography (RIP) bands. All these are used and other than that some additional equipment is required on the child and they are poorly treated by the young children who are present. When pediatric patients are considered, every step should be carried out adequately, it is also essential to ensure that every precautionary measure needs to be adopted effectively (Diakatou & Vassilakou, 2022). The importance of nutrition in children with cancer is indisputable. Nutrition influences most cancer control parameters in pediatric oncology, including prevention, epidemiology, biology, treatment, supportive care, recuperation, and survival. It is widely recognized that the nutritional status (NS) of children diagnosed with and treated for cancer will be probably affected during the course of the disease.

References

Barbi, E., Marzuillo, P., Neri, E., Naviglio, S., & Krauss, B. S. (2017). Fever in children: Pearls and pitfalls. Children (Basel, Switzerland), 4(9), 81. https://doi.org/10.3390/children4090081

Diakatou, V., & Vassilakou, T. (2020). Nutritional status of pediatric cancer patients at diagnosis and correlations with treatment, clinical outcome and the long-term growth and health of survivors. Children (Basel, Switzerland), 7(11), 218. https://doi.org/10.3390/children7110218

Fontenot, N.M., Hamlin, S.K., Hooker, S.J., Vazquez, T., & Chen, H.M. (2022). Physical assessment competencies for nurses: A quality improvement initiative. Nursing Forum, 57(4), 710–716. https://doi.org/10.1111/nuf.12725

Herbert, A., Pearn, J., & Wilson, S. (2020). Normal percentiles for respiratory rate in children-reference ranges determined from an optical sensor. children (Basel, Switzerland), 7(10), 160. https://doi.org/10.3390/children7100160

Huber, B.J., & Epp, S.M. (2022). Teaching & learning focused physical assessments: An innovative clinical support tool. Nurse Education in Practice, 59, 103131. https://doi.org/10.1016/j.nepr.2021.103131

Kinyon, K., D'Alton, S., Poston, K., & Navarrete, S. (2021). Improving physical assessment and clinical judgment skills without increasing content in a prelicensure nursing health assessment course. Nursing Reports (Pavia, Italy), 11(3), 600–607. https://doi.org/10.3390/nursrep11030057

Linders, M., Binkhorst, M., Draaisma, J. M.T., van Heijst, A. F.J., & Hogeveen, M. (2021). Adherence to the ABCDE approach in relation to the method of instruction: A randomized controlled simulation study. BMC Emergency Medicine, 21(1), 121. https://doi.org/10.1186/s12873-021-00509-0

Peran, D., Kodet, J., Pekara, J., Mala, L., Truhlar, A., Cmorej, P. C., Lauridsen, K. G., Sari, F., & Sykora, R. (2020). ABCDE cognitive aid tool in patient assessment - Development and validation in a multicenter pilot simulation study. BMC Emergency Medicine, 20(1), 95. https://doi.org/10.1186/s12873-020-00390-3

Sakai-Bizmark, R., Mena, L.A., Kumamaru, H., Kawachi, I., Marr, E.H., Webber, E. J., Seo, H.H., Friedlander, S. I.M., & Chang, R.R. (2019). Impact of pediatric cardiac surgery regionalization on health care utilization and mortality. Health Services Research, 54(4), 890–901. https://doi.org/10.1111/1475-6773.13137

Sapra, A., Malik, A,, & Bhandari, P. (2023). Vital sign sssessment. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553213/

Toney-Butler, T.J., & Unison-Pace, W.J. (2022). Nursing admission assessment and examination. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493211/

Zemaitis, M.R., Planas, J.H., & Waseem, M. (2022). Trauma secondary survey. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441902/

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