Clinical Incident of Patient A: Lessons for Professional Practice

401021 Being a Professional Nurse or Midwife – Assessment 2
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Q1. What happened in this clinical incident?
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).
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