Objective structured clinical examination Assessment of Critically Ill Patient Essay

This essay will critically analyse my performance end-to-end the Objective structured clinical examination (OSCE) judging I completed, including the escalation scheme utilised by the Nation early warning scores (NEWS) (RCP, 2012) as a track and trigger tool (NICE, 2007). Based on the findings from the evaluatement interventions will be recommended and supported by evidence and formatted on the ABCDE come on I expenditured in the OSCE.The ABCDE discernment is used as a tool to assess for the critically ill patient roles Airway, breathing, circulation, disability & elimination. (RCUK, 2005). It is a taxonomical approach that groundwork assess the severity of the critically ill patient, assess and treat vivification threatening conditions and have rapid intervention when take (Grindrod, 2012). During the Assessment I introduced myself to Mrs Jones to remained respectful, non-discrimitive and ensuring the comfort and dignity of my patient, to which I pulled the curtains (NMC, 2008).I gained oral consent from the patient to carry out the physical assessment (NMC, 2008), although I should have gained consent at the beginning when I started talking to the patient. This is in-chief(postnominal) because the patient needs to understand the proposed assessment, according to the NMC (2008) the process of establishing consent should attest a clear direct of accountability. If consent is refused therefore the patients wishes should be respected although the patient needs to be fully certain of what can happen (NMC, 2008).Standard precautions ar put into place in the clinical setting to protect patients and staff which are vulner equal to(p) to infection. intoxicant based hand rubs are at the point of contact of for each one patient (NPSA, 2008) to help prevent hospital acquired infections and cross contamination (DOH, 2009), which I used prior to seeing Mrs Jones. Airway The assessment of Mrs Jones airway went swell up I assessed for an open airway by alk ing to her to see if there was every vocal response, Mrs Jones responded coherently so there was a patent airway, no noises were heard which can indicate partial obstruction of the airway (RCUK, 2010). Mrs Jones was able to cough to clear secretions independently. Lack of atomic number 8 can lead to anaerobic respiration at a cellular level which produces acidosis as soak up is produced which can lead to hypoxia (Jevon, 2011). Breathing I looked for evidence of hypoxaemia by assessing mouth and oral mucosa for central cyanosis (ODriscoll et al, 2008), none was evident.Respiratory rate was assessed everyplace 1 full minute to ensure accuracy (Hunter, 2008) as difference of opinion of 4 or more can be clinically important (Subbe, 2006) The rate was raised at 24 which I record book on the observation chart and the resperation rate falls in the orange border generating a score of 2, The acceptable regulation respiration rate is 14 18 breaths per minute (Mallett & Doherty, 2001) indicating Mrs Jones could be compensating for metabolic alkalosis and It also contri just nowes to the diagnosis and vigilance of a variety of pathological conditions and helps to evaluate therapeutic interventions.Monitoring the patients respiration level is one of the most accurate indicators of declination, which is practically poorly monitored and recorded Cretikos (2008). Accessory muscles should have been observed to assess for append work of breathing, which would result in inadequate ventilation and poor spoil exchange (Esmond, 2003). Oxygen saturations are considered the fifth vital sign (BTS,2008), and these were decreased at 93 %, normal range is 94% to 98% (BTS, 2008). I record on the observation chart whichs generates a score of 2.The medicine chart was chequered to see if target saturation has been identified and oxygen prescribes as per BTS (2008) guidance, and so 2L of oxygen was give via a nasal cannula to increase saturations to within target range. Mrs Jones was also sat up to increased operating(a) residual capacity which helps to reduces the work of breathing helping to improve oxygenation (Kennedy, 2007). As per BTS (2008) guidance saturations were checkered after 5 minutes and had risen to within target range.Crackles were heard on inspiration when I listened to Mrs Jones chest, this can be an indicator for pulmonary Oedema or pneumonia (Sheppard, 2003). Circulation Mrs Jones looked unsettled and felt serene and clammy, her radial pulse was easy to palpate but was very arcsecond which made me instigate an ECG, manually Mrs Jones pulse was 85bpm but recorded on the ECG was 114bpm that showed evidence of atrial fibulation (AF), the patient didnt have a history of AF. Capillary refill was just over two seconds and melodic phrase pressure was115/85, I did not calculate the pulse pressure or arterial pressure.Her temperature was within normal range at 36. 3. I record the observations and the heart rate falls in orange band gen erating an additive score of 1. Mrs Jones explained that she had passed urine 5 hours ago which was 200mls. NICE (2007) state that an big urine output should be measured at 0. 5mls/kg/hr, I knew this was low for the patient but I did not use the calculation to work out how much it was an hour, volumes of less than 0. 5ml/kg/hr can indicate cardiovascular compromise and renal impairment can occur (Dutton, 2012).Mrs Jones has signs of ankle dropsy, which made me concerned for her fluid status so a fluid chart was commenced of intake and output. Disability Mrs Jones was awake and responding to myself utilize the AVPU tool, The AVPU scale is a quick and easy method to assess level of consciousness which can be affected by hypoxemia and hypercapnia (Palmer et al, 2006). It is idol in the initial rapid ABCDE assessment (Smith, 2003) although a full assessment would require using the Glasgow coma scale (NICE, 2007).Mrs Jones blood glucose level was checked as this can rise as a result of sympathic activation, but the level is within normal range. Exposure With Mrs Jones consent I checked her invasive lines for phlebitis and her skin for any rashes, erythema or signs of pressure sores, all were normal and no phlebitis was noted. I did not assess to see if Mrs Jones had sacral Oedema, oedema only becomes apparent when the interstitial volumes has increased by 2. 5 3L (Porth, 2007) thinkable caused by heart failure. Care EscalationI documented all the patients observations on a NEWS Chart which generated a score of 7, this score then gives me appropriate actions to take as there is a marked deterioration of the patient. 7 or more triggers the Action of escalating make out by contacting the medical examination registrar looking after the patient and also consider go the patient to a level 2 or 3 care facility. When contacting the registrar I used the Situation, background, assessment and recommendation (SBAR) briefing pose to tell the medical registrar about t he patient so they are fully aware of the patient and their condition and actions I want them to take.The handover I gave to the registrar was slightly muddled and I jumped back and forth kinda of remembering the systematic order that the tool was designed for there for I missed out information about Mrs Jones that could of been highly important to the doctor. end point The ABCDE assessment gives health care professionals a framework which helps detect life threatening conditions and are addressed early. The patient I had during my assessment had a lot of complex issues but This approach helps remember the essential things and interfere and referring along the continuum of A to E helped reduce further determination progressing.