PLEASE REFER TO THE CASE STUDY attached Details Students will apply their clinical reasoning skills and critically examine a case study where a person experiences a deterioration in clinical...

Bachelor of Nursing
Subject: SNUG301 (21) Managing Deterioration
Assessment name: Assessment 2- Case Study
Student name (number):
Date Submitted: 8th April 2021
Words: 2000 words
Table of Contents
Introduction    3
Clinical decision making    3
Pathophysiology    5
Clinical interventions    6
Conclusion    7
References    9
Introduction
Two major components of nursing include clinical decision making and clinical reasoning skills that tends to enhance people centred care as well as effective prevention of patient’s deterioration in a proper professional clinical setup. Also, nurses need to
ing and conduct several effective interventions clinically by showing reflection of the previously formulated decisions regarding specific patients that led to patient’s significant deterioration in past (LeGrande, 2016). There is need to have
oad and deep clinical reasoning skills understanding so as to improve the critical thinking along with nursing judgment. Patient’s pathophyisological conditions does also play vital role and is quite crucial to assist nurses in monitoring as well as treating the patients in effective manner (LeGrande, 2016). The focus of this assessment is regarding a case study where the name of patient is Raymond Channing who is 45 years old and is suffering from GORD that is gastro oesophageal reflux disease along with several other complications as well at the time of hospitalization. The assessment tends to describe the actions taken by nurses firstly followed by the decisions made leading to Raymond’s clinical deterioration with the help of clinical reasoning cycle. Afterwards, pathophysiology of Raymond is described regarding the cu
ent condition with the focus on varying clinical data as provided associated with his illness. Finally, the assessment would move towards providing immediate as well as short term clinical interventions to be implied for future practice so as to prevent the clinical deterioration by using varying guidelines or clinical practices.
Clinical decision making
Clinical decision making towards the case of Raymond will be done by the health professionals does include the assessments, communication, monitoring as well as interventions initiated by the nurses leading to Raymond’s clinical deterioration with the help of CRC. So, the Raymond on March, 2 came to Emergency department at around 2200 hours while he complained for the acute severe epigastric pain. His history stated GORD issue, high cholesterol, endoscopy, glucose tolerance as well as obesity. On March, 6 at around 0120 hours, there was abnormality seen in his clinical vital signs which were hypoxic (SPO2 90 percent on RA), tachypnic (22 bpm RR), tachycardiac (139 bpm), hypotensive (90-55 mm Hg), temperature 380C, ve
al on response, GCS 14/15 and mild pain. Apart from these, additionally there were abnormal signs of hyperglycaemic (BGL 24mmol/L), decreased urinary output and capillary refill of 3 seconds.
With these vital abnormally, it was clear that medical history of Raymond also included the positive glucose tolerance test that was conducted around 6 weeks prior of him being hospitalized to emergency Department. He also does have family history of diabetes. It must be noted that there was no action from nursing department on this by the nurses in Emergency Department till 4 days of his hospitalization due to which the blood glucose levels further raised up to 45mmol/L. This could be a MET call requiring medical emergency as per Torabi et al (2017). Thus, it would not be wrong to say that nurses failed to monitor blood sugar level of Raymond over the 4 days leading to further deterioration in clinical signs of his health like consciousness level, bica
onate level-10, BE-6 and ABG gases like acidic pH 7.28 and PaCO2 -35. Further analysis states that there was failure of nurses to manage pain levels effectively as complained by Raymond. This could be because of improper analgesics or opioids administration except for pantaprazole which was administered for his gastritis until severe pain was observed as per clinical review. One of the core roles for nurses working in Emergency department is pain assessment in effective manner followed by pain management initiation for the patients (Marco et al, 2020). However, it was observed that nursing staff looking after Raymond worked on only his pain documentation that states how it was deep, sharp as well as consistent rather than doing any intervention to reduce or manage pain except waiting for review from surgical team which was to happen after 18 hours.
Also, there could be interpretation regarding multiple vomits by Raymond in last 3 days with increased urinary output and minimal intake of fluid but still there was no administration of IV fluids to him that could have resulted in potential dehydration as evident by the hypotension, tachycardia, low urine output, increased capillary refill as well as hyperkalaemia (Huang et al, 2018). Furthermore, the initiation of fluid balance chart is also been missed out by nurses for Raymond until 4th day of his presentation in ED even though there were vomiting records already and since the time of admission, there was decreased fluid intake too. Also, above this in case of tachycardia, the patient’s
eathing work has been increased and there was need to initiate ECG by the nursing staff so as to diagnose the abnormal cardiac output or the a
hythmias (Henning & Krawiec, 2020).
Signs of deteriorations can be analysed well from the case study since his hospitalization to Emergency...