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Adult Nursing Interventions by Analysing a Case Study

Introduction

This essay aims to discuss adult nursing interventions by analysing a case study. Following the Nursing and Midwifery Council (2018), the pseudonym Mary White has been used to respect the privacy and confidentiality of the patient. Mary is a 75-year old female who had a history of back pain and dementia. In this essay, Mary’s case would be used to discuss the principle role of a competent clinical nurse for effectively assessing the patient and making the correct diagnosis of the disease followed by the development of a treatment plan.

Discussion

Nurses are required to form effective communication skills with the patient in order to provide high-quality care for dementia patients. Usually, through communication, the mental state and alertness of the patient are also analysed. Moreover, the essential role of nurses is to conduct the physical examination of the patient within primary care. Due to Mary’s history of Dementia and backache, she was on house care however, after she appeared to be drowsy, had gurgling sound with snores, and was receptive to pain, she was brought in the acute holistic settings. Therefore, Mary’s health would be evaluated by using the ABCDE approach which is a standard mode of assessment usually undertaken on chronically ill patients. This approach would enable healthcare practitioners to determine the most befitting (Resuscitation Council, 2020). 

Initially, Mary’s airway was analysed for identifying signs of partial or complete obstruction which were absent. Next, Mary’s breathing rate was measured and, her breathing rate was 12 breaths per minute which were normal while, her oxygen saturation was 93% therefore 2L of O2 by nasal cannula was given and appeared lower than the ideal 100% saturation likewise, her chest was found to be clear which diminished the risk of any lung infection. 

During the assessment, it is crucial to evaluate the circulation rate of Mary for determining any unidentified cardiac impairments. Therefore, upon examination, Mary’s Heart rate was normal i.e. 100 Bpm, her blood pressure was 130/80 mmHg and capillary refill time was 3 seconds. Overall her circulation was found in the normal range. Next, Mary’s physical examination was conducted to identify the presence of injuries or swelling and bruises indicating signs of fall. However, there weren’t any signs of bruises or rashes and her temperature was a standard 36.4 0C   therefore the presence of any infectious agent was also removed.  Furthermore, throughout the examination, Mary’s eyes were closed due to her drowsiness but, her pupils were uniformly reactive with a 2mm size. After 1 minute, when Mary’s alertness was determined, she still appeared less responsive, therefore, as per the guidelines; the entire assessment was repeated after an interval. Mary’s vital sign reading was similar as earlier, however, the Glasgow coma scale reading were E2V2M3.  

The “National Early Warning Signs Score (NEWS)” was obtained which enable the nurses to determine the presence of potential risk in the patient; Mary’s NEWS score was 9 points which is indicative of the need for an emergency examination performed by a clinical nurse or critical care team who have the expertise in this area. Thus, Mary would be transferred to a the unit of high dependency where she would be observed by the critical care team (McGinley & Pearse, 2012). Therefore, after the arrival of the medical registrar and the samples would be taken given that Mary had a history of Dementia and moaned on pain examination in her back, she was recommended for a CT scan to be taken.  During this stage, it is crucial for the healthcare staff to work collaboratively for providing timely and effective care to the patient in a team.

Moreover, as per Ervin et al. (2019), the nurse leader must ensure that the teams have the emotional and physical skills to work in all kinds of settings and, collaboratively work towards a mutual objective that is focused on the patient’s health. Therefore, for Mary’s care and treatment the outreach team would be responsible to work in collaboration and the ITU registrar is responsible for securing the airway adjunct (i-gel) as well as preparing the constant care. 

Within the clinical settings, the NMC and NHS guidelines demand the nurses to have effective communication with the patient, create an open-channel with the patient where there is a discussion regarding health and treatment plan (Håkansson et al., 2019). Therefore, in the case of Mary, her carer effectively participated in Mary’s care and mentioned that she had been regularly taking Codeine for her headaches. Codeine is an opiate and used to treat mild to moderate degrees of pain. Healthcare workers are usually trained to determine the risk factors and, are required to prioritise patient safety at all costs (Lundberg, 2017). Similarly in Mary’s case, the nurses are required to make effective decisions for her and form a treatment plan which would have positive health outcomes.  Likewise, because of Mary’s history of medications and her current physical state, she has been prescribed an infusion of naloxone. It was observed that after the infusion of the drug, Mary started to gain consciousness and started to mumble some words to communicate. She had a cough due to which her nasal adjunct was removed. Upon repeated assessment, her vital signs, circulation, and temperature were all under the standard range with her pupil dilation being normalised and sensitive to light. 

Through this case study, I was able to reflect upon the significance of the practical duties and responsibilities of nurses. It was fortunate that Mary’s carer immediately observed her impaired alertness and brought her to the acute holistic settings.  These case studies made me realise that nurses must stay calm and adjust themselves in accordance to the situation and environment. Through the correct assessment and evaluation of the patient can influence the treatment plan and the next steps of the treatment therefore, nurses are required to make the correct diagnosis of the patient’s health and mental state. 

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Conclusion

The present essay evaluated the clinical skills and duties of the nurses in the adult care ward. For this purpose, the case study of Mary White was discussed. Through this essay, it can be concluded that elderly patient especially with a history of medications and diseases are extremely vulnerable. In such cases, nurses play a vital role in working in collaboration and performing the initial primary care examinations through which a patient’s health is analysed and the diagnosis of care can be made. Thus, nurses must develop the necessary skills that could omit medical errors and support them in the provision of safe and high-quality patient-centred care. 

References

Ervin, J. N., Kahn, J. M., Cohen, T. R., & Weingart, L. R. (2018). Teamwork in the intensive care unit. American Psychologist, 73(4), 468.

Håkansson, E. J., Holmström, I. K., Kumlin, T., Kaminsky, E., Skoglund, K., Höglander, J., ... & Summer, M. M. (2019). " Same same or different?" A review of reviews of person-centered and patient-centered care. Patient education and counseling, 102(1), 3.

Lundberg, K. G. (2017). Dementia Care Work Situated Between Professional and Regulatory Codes of Ethics. Ethics and Social Welfare, 12 (2), 133− 146.

McGinley, A., & Pearse, R. M. (2012). A national early warning score for acutely ill patients.

Nursing and Midwifery Council. (2018). Professional standards of practice and behaviour for nurses, midwives and nursing associates.

Resuscitation Council, U. K. (2020). The ABCDE Approach. resus. org. uk/resuscitation-guidelines/abcde-approach. Last accessed, 11.

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