What happened in this clinical incident
What activities did the nurse or midwife need to complete in the immediate situation
What professional behaviours may have made a difference in this situation
What do you learn from this case study about your own preparedness for professional practice.
Immediate interventions for critical patients
The clinical incident is about patient A, an 81 years old woman who has died due to septicaemia. She has visited a GP when suffering from breathlessness. She was recommended to have oral Lasix and further clinical review after 2 days. Meanwhile the patient has visited a local hospital as her health condition did not improved. During hospitalization VMO has reviewed the condition of the patient.
The vital assessment has shown increase in the heart rate, respiratory rate, atrial fibrillation and tachycardiac measure. She has refused to take food and liquid and reported about her abdominal pain and weakness. After observing the patent the VMO has concluded that the patient was suffering from depression and anxiety. Further assessment was done as the patient has refused to take dinner.
The patient has administered medication recommended by the VMO. The patient condition became more critical and pale clammy skin, nausea, immobilization due to pain, increase in WBC and infection in urinary tract have been reported. Next day registered nurse has attended the patient and identify dizziness, abdominal pain, low blood pressure and high respiratory and heart rate. Furthermore continual diarrhoea has been reported. However, the registered nurse did not documented such condition.
The registered nurse has called Clinical Nurse Manager but did not discuss about the sever condition of patient A. ISBAR was performed and deteriorating health condition have been marked. In such emergency, doctor has attended the patient and use IV cannula to treat dehydration. However, due to lack of interventions regarding initial care the patient has died.
Q2. What activities did the nurse or midwife need to complete in the immediate situation?
As the patient was admitted due to severe breathlessness it was important to assess the vital signs properly to identify the problems of the patient. In this situation the nurse should have been assess the vital signs such as blood pressure, respiratory rate, heart rate and body temperature. The nurse should have been ask the patient about past history of health and abut her current medication (nursingmidwiferyboard.gov.au, 2018). It could help the nurse to identify if the increase in the breathlessness is due to the side effect of any drug such as Lasix (Mickelson, Willis & Holden, 2015).
As the patient was reported high respiratory rate and shortness of breath it was important to assess the air way and provide adequate oxygen therapy to the patient to relief the patient. In this regards the nurse should have tell the patient regarding the importance of oxygen therapy as it could help the nurse to make patient comfortable with the treatment and reduce depression and anxiety (You et al., 2013). Adequate medication should have been provided to the patient.
However, digoxin and valium have been recommended to reduce the breathlessness and anxiety. In addition the nurse should have tell the patient to use relaxation technique to reduce rapid heart and respiratory rate and could help to manage pain and help the patient to improve mobilisation (Karlen et al., 2013). As the health condition of the patient was deteriorated it was important to provide proper diagnosis such as chest x-ray, MRI, ECG and blood test. It could help the health professional to identify the underpinning health issues such as any infection in lungs or bloodstream (You et al., 2013).
Assessment and diagnosis of patient
Nursing care means not only provide treatment but also encourage the patient to involve in the treatment in an effective manner. In this case the patient has refused to take food and fluids. Such condition has affected her health thus her blood pressure became low and she was suffering from weakness and nausea as well. In this situation the nurse should have provide mental support and tell her about the importance of healthy diet to recover faster (You et al., 2013).
It could help the nurse to convince the patient to take food and fluids. Furthermore, the nurse should have incorporate IV fluids to provide adequate nutrition to the patient. It could help to reduce the risk of diarrhoea and dehydration as well. In order to reduce the pain the nurse should have provide medication.
Increase in the WBC sometimes related with infection. As pathogen increases in the body the number of WBC also increases to protect the body from the pathogens (Erba et al., 2013). In this case the nurses should have taken proper infection control interventions and medications. Such immediate actions taken by the nurse could have reduce the risk of septicaemia and save the life of the patient.
Q3. What professional behaviours may have made a difference in this situation?
Enormous mistakes in the behaviour of the registered nurse have been found in case of patient A. The registered nurse did not documented the health condition of the patient which was a major mistake and ignorance of responsibility of a registered nurse. Such activity could lead to miscommunication regarding the health information of the patient. On the other hand the registered nurse has called the clinical nurse manager for the medication of other patients but did not discuss about the severe health condition of patient A, which was another irresponsible action.
Furthermore, the registered has failed to establish effective relationship with the patient thus has failed to convince the patient to have food. Such poor quality of service has contributed to the severe health condition and death of the patient. The nurse should know how to take care of a critical patient and should comply with the standard of NMBA to provide quality service and ensure patient safety (nursingmidwiferyboard.gov.au, 2018).
In this case at first the registered nurse should have assessed the patient properly and document each minor to severe details about the health condition of the patient. The NMBA standard of practice has mentioned in the standard 4 that it is important to introduce holistic assessment to identify the severity of the patient (nursingmidwiferyboard.gov.au, 2018). Documentation of health condition is another important duty that the registered nurse should have maintain properly.
The standard 5 of NMBA has indicated the importance of prepare proper care plan (nursingmidwiferyboard.gov.au, 2018). Documentation is a vital part of nursing care plan as it helps to identify the area of priority and helps to introduce proper treatment. The standard 2 of NMBA recommended to establish effective therapeutic and professional relationship (nursingmidwiferyboard.gov.au, 2018). The registered nurse should have discuss with the clinical nurse manager about the severe health condition of the patient. In this case the clinical nurse manager could have provide effective medicines that could help to relief the pain, diarrhoea or dehydration.
Such collaboration would help to improve the quality of care and patient safety (safetyandquality.gov.au, 2018). Furthermore, the nurse should have inform the patient about the treatment process and its effectiveness. It could help the nurse to involve the patient in treatment and convince her to eat food (Faden et al., 2014). Such behaviour could help the nurse to improve the service and save the life of the patient.
Q4. What do you learn from this case study about your own preparedness for professional practice?
The clinical situation was about Patient A, who has died due to lack of adequate care. I have identified the consequence of lack of care and not fulfilling duty in the health care settings by health professionals. I feel that there is lack of awareness regarding the importance of patient safety. The nurses learned about the standard of practice but they fail to apply such standards in the nursing practice. Thus fail to achieve expected outcomes. I have learned about the importance of vital sign assessment and initial care from the case. The case has helped me to identify the importance of establishing effective relationship with the patients and other health workers.
I have learned about the management of a patient breathlessness and primary care that need to do in such critical cases. It has helped me to understand how documentation could help to introduce effective care plan. I have identified that the culture of safety and communicate effectively with patient and other health professional is interlinked with each other. I have realised how the irresponsible activity of one person leads to harmful outcomes and death as well. After learning from this experience I would like to utilise all the guidelines provided by NMBA in my clinical practice. Maintaining such guidelines could help me to improve my skill, provide quality service and ensure patient safety.
Erba, P. A., Sollini, M., Conti, U., Bandera, F., Tascini, C., De Tommasi, S. M., ... & Lazzeri, E. (2013). Radiolabeled WBC scintigraphy in the diagnostic workup of patients with suspected device-related infections. JACC: Cardiovascular Imaging, 6(10), 1075-1086.
Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014). Informed consent, comparative effectiveness, and learning health care. N Engl J Med, 370(8), 766-768.
Karlen, W., Raman, S., Ansermino, J. M., & Dumont, G. A. (2013). Multiparameter respiratory rate estimation from the photoplethysmogram. IEEE Transactions on Biomedical Engineering, 60(7), 1946-1953.
Mickelson, R. S., Willis, M., & Holden, R. J. (2015). Medication-related cognitive artifacts used by older adults with heart failure. Health policy and technology, 4(4), 387-398.
nursingmidwiferyboard.gov.au (2018). Nursing and Midwifery Board of Australia - Registered nurse standards for practice.
You, L. M., Aiken, L. H., Sloane, D. M., Liu, K., He, G. P., Hu, Y., ... & Shang, S. M. (2013). Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses and patients in hospitals in China and Europe. International journal of nursing studies, 50(2), 154-161.
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