Management of Critical Illness

This essay discusses the nurse's role in efficient patient care and how to manage critical illness. It covers the methods of assessment used to recognize declining clinical conditions, potential complications, and interventions. The essay does not mention any specific course code or college.

Running head: MANAGEMENT OF CRITICAL ILLNESS
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Management of Critical Illness
Name
Institution

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Management of Critical Illness
Introduction
Critically ill patients normally have altered psychological states and this puts them at a
huge risk of experiencing deteriorating conditions. According to Subbe & Welch (2013), these
deteriorating conditions gradually develop over numerous hours. The conditions can be
suspected if abnormal vital signs start showing in the patient. These abnormalities start showing
once the respiratory, cardiovascular, and neurological systems start failing (Tinker & Rapin,
2013). It is important to detect these psychological abnormalities soon enough to prevent the
escalation of the condition into a more critical situation. A nurse is the most suited individual
when it comes to the observation and assessment of the patient. The nurse then intervenes to
prevent health deterioration (Silva et al. 2015).
The number one priority for nurses and health practitioner is the safety of their patients
especially the critically ill patients. Morton, Fontaine, Hudak, & Gallo (2017), ascertain that it is
the responsibility of the nurse to detect a patient’s worsening conditions and intervene promptly
to prevent unintentional harm to the patient. A health practitioner needs to observe and document
the patient’s physical conditions that may cause hemodynamic instability. An effective nursing
observation is, therefore, vital when it comes to the identification of any signs and symptoms of
medical. (Michelle Aebersold & Dana Tschannen, 2013). The aim of this essay is to discuss a
nurse’s role in efficient patient care. The essay further addresses any potential complications that
Mrs. Beverley Smith might encounter due to her conditions. We will then analyze the possible
interventions that the nurse can use to counter Mrs. Smith complications.
Registered Nurse Best Practice in the Care of Critically Ill Patients

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Nurses have become more focused on recognizing and responding to patients’
deteriorating health conditions in the recent past. A patient’s declining health conditions may in
some cases fail to be recognized early enough to enable prompt intervention. This failure can
escalate to critical illness if a response is not initiated soon enough (Douw et al., 2015). Below
are the methods of assessment used to recognize declining clinical conditions.
Assessment of the Patient
Patient assessment is very significant in identifying the deteriorating clinical conditions
of the patient. It enables the nurse to identify the worsening health conditions in a timely manner
and respond to them appropriately (Tinker & Rapin, 2013). Observation and recording of the
vital signs such as the rate of heartbeat, temperature, respiratory rate, and blood pressure are
important in assessing the patient and recognizing deterioration (Curry & Jungquist, 2014).
Studies reveal that alterations in the vital signs of the patients are enough indicators of declining
health conditions. There are two types of assessment that include the primary assessment and the
secondary assessment.
Primary Assessment of a Critically Ill Patient
Primary assessment is used during the initial stages of assessment. It can also be referred
to as the ABCDE approach that means the Airway, Breathing, Circulation, Disability, and
Exposure approach (Munroe, Curtis, Considine & Buckley, 2013). The primary assessment has
several aims that include saving lives, breaking down complicated clinical situations into ones
that can be managed with ease, granting the healthcare providers adequate time to develop a final
diagnosis and treatment plan, and serving as an assessment and treatment algorithm (Munroe et
al., 2013).

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The letter A is an acronym for Airways. It requires a nurse to assess and treat the
obstruction of air. Obstruction of air is either partial or complete. Partial obstruction is
characterized by noisy breathing, difficulties in breathing, and a changed voice. A chin-lift and a
head-tilt maneuver are used to remove airways obstruction. According to Odell (2015), failing to
treat air obstruction may lead to reduced levels of partial pressure of oxygen and oxygen
saturation. From the case study that we are presented with, Mrs. Smith’s oxygen saturation is
89%. The normal oxygen saturation, however, is 95-100% (Odell, 2015). This situation may,
therefore, prompt the attending doctor to add Mrs. Smith more oxygen.
An assessment of her breathing must be assessed to ensure that it is sufficient. This is
represented by an acronym B. This assessment is used to inspect the respiratory rate, movements
of the chest cavity, and the value of SpO2. From the presented scenario, we can notice some
abnormal readings such as SpO2 of 89% and respiratory rate of 32 breaths per minute. As Adam
(2017) confirms, broken ribs may incapacitate the lungs and cause cyanosis which results in
inadequate oxygen transfer in the body. An assisted ventilation may, therefore, be recommended.
Circulation represented by C is the next step in primary assessment. This assessment is
used to inspect the pulse rate and the blood pressure. It may be necessary to perform skin
inspections to notice any symptoms of poor circulation. A blood pressure of 95/50 mmHg may
be a sign that Mrs. Smith has hypotension. The patient should, therefore, be placed in a supine
position before the nurse can obtain an intravenous access to infuse saline. Hypotension is one of
the indications of poor blood circulation in the body (Brown, Edwards, Seaton & Buckley,
2017).

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The next step in the primary assessment is D which is an acronym for disability. It is used
to assess the level of consciousness of the patient (Adam, 2017). An assessment should be done
to confirm whether Mrs. Smith is alert, voice responsive, pain responsive, or unresponsive.
Acronym E represents exposure which is commonly used to inspect the body temperature. A
tympanic temperature of 37.8℃ is slightly higher than normal. A thorough physical examination
should be used to assess Mrs. Smith or any signs of bleeding or trauma (Vaughan & Parry,
2016). There are two other steps represented by F and G. F is used to assess the fluid balance.
Mrs. Smith has a reduced urine output as revealed by the case study. Acronym G stands for
glucose and it is used to assess the blood glucose level.
Secondary Assessment of a Critically Ill Patient
Secondary assessment includes an assessment of the head, thoracic region, abdominal
region and long bones. Brown et al. (2017) ascertain that the physician is required to observe the
face and ears of the patient for any kinds of abnormalities. An observation of Mrs. Smith lips
may also be important to identify any symptoms of cyanosis particularly due to the fact that she
has fractured ribs which may incapacitate the lungs.
The next step is the assessment of the thoracic cavity. During this assessment, the
practitioner checks whether chest expansion is symmetric or asymmetric. According to Vaughan
& Parry (2016), asymmetrical movements of the chest may be an indication of fractured ribs like
in Mrs. Smith’s case. A suitable intervention is then initiated post this assessment. The next step
is the assessment of the abdominal region which is done to check for any signs of wounds,
injury, and bruises. The nurse can easily notice the large skin tear on her right arm during this

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assessment. Finally, the long bones are assessed to check for any signs of swelling or
discoloration (Vaughan & Parry, 2016). Discoloration may be due to of cyanosis.
Mrs. Smith’s Potential Complications
The revelations from the case study indicate that Mrs. Smith fell and fractured her ribs.
The nurses recognize her deteriorating clinical conditions upon her admission to the hospital.
The nurses make several observations that include a blood pressure of 95/50 mmHg, a pulse rate
of 110 beats per minute, a respiratory rate of 32 breaths per minute, and a tympanic temperature
of 37.8º C. Furthermore, she has an indwelling catheter in-situ. An assessment of these
observations indicates that Mrs. Smith’s condition is crucial and it may lead to several other
complications. Below, we will discuss some of the potential complications.
Hemodynamic Complications
Hemodynamics is common during intra-hospital transfer of the critically ill patients like
Mrs. Smith and it should, therefore, be handled with extreme care. Normally, when a critically ill
patient is transferred from one section of the hospital to the other, their blood pressure may drop
substantially. This decrease in the blood pressure may be accompanied by an increase in the rate
of the heartbeat of the patient. Morton et al. (2017), additionally confirms that the use of an
indwelling catheter can contribute to hemodynamic complications.
From Mrs. Smith’s assessment, we are informed that her blood pressure is 95/50 mmHg
which is extremely low when compared to the normal blood pressure. If we compare her pulse
rate with the normal rate which is 60-100 beats per minute, we realize that her pulse rate is
slightly higher at 110 beats per minute. An assessment of Mrs. Smith’s respiratory system

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reveals that the bilateral entry of air has been reduced in addition to having an indwelling
catheter. She is also on a cardiac monitor that helps in checking the rate of her heartbeat.
The above assessments prove the possibility of complications due to hemodynamics. A
postoperative intra-hospital transfer causes cardiac instability among the critically ill patients.
This is enough to establish that Mrs. Smith is at a risk of encountering a hemodynamic
complication.
Catheter-related UTI
Using an indwelling catheter for extended periods of time is a major cause of Catheter-
Associated Urinary Tract Infection (CAUTI). This infection is one of the most common
complications. This complication due to CAUTI may result in increased septicemia, urosepsis,
and mortality. According to Nicolle (2014), catheters act as an ideal environment that enhances
the growth of bacteria. This is so because the biofilms of the bacteria adhere to the surfaces of
the catheter system. After the insertion of the indwelling catheter into the body, bacteria quickly
grow in colonies that rapidly adhere to the walls of the catheter system. Chenoweth & Saint
(2013), confirm that the peri-urethral region is full of numerous bacteria and these bacteria main
gain an access into the urethra at the time of the insertion of the catheter. It is also important to
note that the inadequate drainage of urine may cause urine stasis. This urine stasis increases the
risks of having bacteria in the urine thus increasing the possibilities of having UTI. Nicolle
(2014), further adds that the presence of the catheter may cause mechanical irritation that may
further encourage the growth of bacteria around the catheter region.
The bacteria responsible for CAUTIs may be introduced into the urinary tract through
either intraluminal or extra-luminal means. Intraluminal contamination occurs as a result of

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bacteria traveling from a drainage tube, a contaminated catheter, or drainage bag. Extra-luminal
contamination, the other hand, may result from the insertion of a catheter that may have been
contaminated from another source. Extra-luminal contamination is the leading cause of bacteria
causing CAUTIs among women. The bacteria can travel through the catheter to the bladder
within 1 to 3 days (Meddings et al., 2013). The main symptoms of catheter-associated urinary
tract infection are fever and confusion.
Sepsis
This condition may result from the body’s response to chemicals that have been released
into the bloodstream to fight a bacterial infection. This complication is life threatening because it
can proceed to a septic shock that causes dramatic drops of the blood pressure that may lead to
death (Adam, 2017). From an assessment of Mrs. Smith, we notice that her pulse rate is 110
beats per minute. Additionally, her respiratory rate is 32 breaths per minute. Furthermore, the
urine output is extremely reduced and her blood pressure is very low at 95/50 mmHg. These
revelations are all possible signs of sepsis that is normally characterized by a reduced urine
output, a respiratory rate above 20 breaths per minute, a pulse rate higher than 90 beats per
minute and an extremely low blood pressure (Adam, 2017). The reduced blood pressure may
lead to a septic shock.
Cyanosis
Mrs. Smith could also possibly suffer from cyanosis from the revelations presented in the
case study. Cyanosis is defined as the bluish discoloration of the nails, skin, and the mucous
membrane. According to McMullen, & Patrick (2013), this condition is caused by the lack of
adequate transfer of oxygen to the body organs. We are presented with a scenario where Mrs.

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Smith is said to have suffered a fall in the garden and broke four of her ribs. These fractures may
incapacitate the lungs thus preventing the lungs from expanding competently which may lead to
low oxygenation of blood in the blood vessels. There is two types of cyanosis namely central and
peripheral cyanosis (McMullen, & Patrick, 2013). A patient suffering from central cyanosis can
easily get an infection of peripheral cyanosis.
An oxygen saturation of 89% that is exhibited by Mrs. Smith is considerably low when
compared to the normal range of oxygen saturation. As a result, the supply of oxygen to her body
organs is inefficient leading to the circulation of blood lacking enough oxygen that is
characterized by a bluish color. This may cause a development of a bluish discoloration of the
lips, skin, the mucous membrane, and nails which are the signs and symptoms of cyanosis.
Interventions against the Complications
Proper nursing interventions are very important in preventing the aggravation of the
complications mentioned above. These interventions guarantee the provision of quality patient
care and at the same time prevent the decline of the clinical conditions of the patient. Below, we
will discuss some of the best nursing interventions that can help in addressing complications in
critical illness.
Permanent or temporary pacemakers are implanted to help in addressing hemodynamic
complications. As Stolic (2013) affirms, a nurse should possess enough knowledge and skills to
appropriately place this device. Additionally, the nurse must be knowledgeable enough on
matters concerning asepsis, and the monitoring and care of a patient undergoing this invasive
procedure (Stolic, 2013). Furthermore, the nurse must be aware of any complications that come
with this invasive procedure including an accidental puncturing of some vessels, infections,

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mechanical failure like battery failure of the pacemaker, and bleeding (Fowler et al., 2014). The
available types of pacemakers include the single chamber, dual chamber, and biventricular
pacemakers.
Routinely changing the indwelling catheter at intervals of 4-6 weeks is recommended to
help in preventing Catheter-Associated UTI. This process is better than the habit of only
changing the catheter when it blocks because it produces better results (Meddings et al., 2013).
Additionally, education of the nurses and other staff is necessary for the proper handling of the
catheter (Chenoweth & Saint, 2013). Through this education, the nurses get the necessary skills
required routinely check the catheter and thus prevent or reduce the possibilities of CAUTIs.
There are three approaches that have been recommended by the CDC to help in
preventing infections that may lead to sepsis. Under the advisement of the doctor, it could be
important to get vaccinated against flu and pneumonia that are considered as potential infections.
Additionally, as a nurse, I have to ensure that the wound on Mrs. Smith’s right arm is clean to
prevent infections (Adam, 2017). Furthermore, I must stay alert to any symptoms of sepsis such
as a rapid heart rate, confusion, fever, chills, and rapid breathing and recommend immediate
medical attention.
Cyanosis, on the other hand, may require surgery as a corrective mechanism. Sometimes,
the nurse is advised to place the nurse in a continuous oximetry. This intervention is important in
detecting the deviations in oxygenation (Wang, 2015). The normal operation of the body is
sustained by oxygen saturation above 90% and it is thus important that the level never falls
below 90. Furthermore, it may be necessary to prepare the patient for intubation. Mechanical
ventilation and intubation are important in maintaining sufficient oxygenation and ventilation

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which ensures that an artificial airway is placed and maintained effectively (Tsui, Chen, Zhou,
Hai & Wang, 2015).
Conclusion
Extensive care is a major necessity for the critically ill patients due to their high risks of
experiencing complicated deteriorating conditions. These declining conditions are characterized
by abnormal vital signs that may involve failing cardiovascular, respiratory and neurological
systems. It is thus important for the nurses to observe and assess these signs in order to prevent
worsening conditions of the patients. After an effective observation and assessment, the nurse
can then make informed recommendations to ensure patient safety. Early recognition and prompt
response to the deterioration of clinical conditions are vital in the nursing practice. The
assessment of patients which includes, primary and secondary assessments help in the
recognition of the deteriorations. Failure to recognize the declining health conditions and
promptly responding to them can lead to other complications such as sepsis, cyanosis, CAUTIs,
and hemodynamic complications. Appropriate nursing interventions can, however, prevent or
reduce these complications.

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