NSB236 Integrated Nursing: Managing Deterioration in Adam's Case

This case study examines the clinical deterioration of a patient named Adam, focusing on the signs and symptoms reported by his family, such as coughing and feeling cold. It identifies hypoxic brain injury as a priority problem due to its impact on respiration, supported by the patient's history of asthma. The essay discusses evidence-based clinical interventions, including pharmacological agents and nursing management, to address the respiratory problem and improve the patient's health condition. The importance of nursing staff in medication management and continuous evaluation is emphasized, aiming to provide better and more effective healthcare treatment. This assignment provides a comprehensive overview of the assessment, diagnosis, and management of clinical deterioration in a patient care setting. Desklib offers a variety of resources, including past papers and solved assignments, to aid students in their studies.

The deteriorating patient

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Identification and discussion about two sign and symptoms of clinical deterioration that is
report by family member........................................................................................................3
Identification of one priority problem which is associated with patient's clinical presentation
with sign and symptoms of clinical deterioration...................................................................4
Discussing evidence based clinical interventions for addressing priority problem along with
evaluating efficacy of interventions.......................................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
Clinical deterioration refers to serious physiologic disturbance or refers to worsening
physiological condition of patient. This is preceded through physiological changes. There are
various reason that leads to worsening of health condition of any individual of patient. There is
declining of health condition even after getting better treatment and care. In this case it is crucial
to identify the sign and symptoms that can provide enough information about the clinical
deterioration that can either report by family member or patient themselves. In this essay there is
identification of one priority problem which is associated with clinical priority. This essay also
consist of evidence based clinical interventions to address priority problem and way to evaluate
their efficacy of those intervention. In this essay, there is deterioration of patient with many sign
and symptoms which leads to create health declination of patient where it is needed to identify
intervention which can help to get better and improved health (Dos Santos, (2020)).
MAIN BODY
Identification and discussion about two sign and symptoms of clinical deterioration that is report
by family member
Adam has poor condition where his mother has informed about two different signs and
symptoms where Adam was feeling cool where even needed blanket and was shivering. There
was also a sign of coughing which has been gradually worsening and needed well treatment and
diagnosis. Coughing and feeling cold are two of the sign or symptom which has been reported
through Adam's mother.
Coughing is the feedback mechanism of body which is there to get rid of an irritant
within throat or airway. Where brain respond and sends massage to chest muscles and abdomen
to get contract and expel burst of air. This is normal mechanism to get rid of any irritant. Cough
is the process where it serves to clear airways when there is large amount of mucus which can be
there due to excessive amounts of some abnormal substance like pus or edema fluid or there is
chance of getting large amount of inhaled materials. In this case there could be chance of getting
effective cough where it effectiveness depends on its ability to drive gas with higher velocity
through Adams airway which is having effective interactions between the flowing of gas and
mucus within airway (Yang, (2021)). This lead to expel any material that have the chance for

creating irritation within Adam's airway. This is the pathophysiology of the cough which impact
Adam's health.
Feeling cold is the feedback mechanism of body which can cause due to many reason.
Due to various diseases or illness created risk of feeling cold where one of the main reason is
getting fever which can be there due to any risk of health where immune system response
towards the foreign particle or any diseases. This refers to an acute illness within upper
respiratory tract caused due to virus that acquired from another individual. Some virus have the
potential to impact respiratory tract like rhinovirus. This is the immune response to the virus to
get rid of it. Mechanism of immune system depends on the virus specific. Respiratory syncytial
virus (RSV), are contracted by direct contact with airborne droplets. It have the specification to
get replicate in throat or nose before spreading to the lower respiratory tract (Pacella, (2020)).
To get diagnose worsening cold, there is need to get in contact with physician or doctor
which can recommend for some test like CBC, throat swab, chest X-ray, viral testing etc. There
is also need for the proper diagnosis of of cough which is also observed within Adam's about
worsening cough for which recommended diagnosis test is CT scan or X-ray, spirometry or a
methacholine challenge test. This is the some of the diagnosis test that can help to identify the
reason of observed sign and symptoms of getting worsening of cold and cough to Adam's.
Identification of one priority problem which is associated with patient's clinical presentation with
sign and symptoms of clinical deterioration
Adam have various clinical problems like worsening of cold, cough, respiration problem,
non-focal seizures, asthma attack and many more. There are many of the health related issues
which are observed when patient was taken to healthcare premises. In all of these clinical illness,
is one of the priority problem which was associated with the patient's clinical presentation which
includes sign and symptoms which represents the clinical deterioration. This is one of the
priority problem because this is related with the respiratory problem where patient was able to
get oxygen through his own in normal way (Preeti, (2019)). There was need to provide oxygen
for smooth respiration and to managing the current worse health condition of patient. When
patient was taken to the healthcare premises for the diagnosis and treatment for his improved
health, patient was admitted to the ICU ward where after diagnosis of hypoxic brain injury he
was admitted to respiratory ward. This shows that hypoxic brain injury is one of the clinical
priority for the Adams current health condition and needed for better and effective treatment.

There was sudden worsening of the Adam's physiological condition which was represented as
the clinical deterioration where Asthma is the past medical condition which leads to create
various physiological impact over the patients current health. Patient was taking corticosteroids
for longer period of time to manage Asthma. Patients was not able to respire effectively and
needed for better respiration with the help of external support which was provided by the
healthcare team at the healthcare premises (Daverey, (2020)). These are some of the evidence
which provides the information about the hypoxic brain injury as a priority problem. These are
the reason which impact the overall health and leads to worsening of Adam's condition which is
associated with the worsening of condition. In this case, selected respiratory problem is the
clinical priority which is associated with the patient's case where after diagnosis of hypoxic brain
injury it has been identified to provide external support for the proper respiration. Due to having
history of Asthma which ensure that Adam's can have higher chance of getting worsening of
respiration which can be there due to having asthma previously. Adam's past medical
information allows to provide information which helps to access interpret that individual can get
worse condition due his medical condition. This allows to focus on the delivery of better and
effective treatment.
Discussing evidence based clinical interventions for addressing priority problem along with
evaluating efficacy of interventions
There are various clinical interventions for addressing priority problem that provides
improvement in current situation and provide better health condition along with evaluation of
efficacy of intervention (Appavu, (2019)).
Pharmacological intervention- There is need for improve treatment which can be taken
in action with the collaboration with patient and his or her substitute decision maker. There
should be clear goal and can have effective outcomes where medication that should have adverse
effect are discontinued and other which are effective should be in process for better and
improved health. There is need for most appropriate agent which can have high efficacy for the
improved outcomes. There is need to use the appropriate agent like psychostimulants,
methylphenidate, antidepressant, Antiparkinsonian drugs, anticonvulsants, and other agents.
These are the pharmacological agents which have their different impact on different symptoms
that can help to provide better response to the Adam's current health condition. In this, nusing
staff have the role to ensure that patient should take the medication at proper time which can help

to provide better and effected health improvement. Nursing staff have the role to take care of
patient and its medication with time to time evaluation that can help to provide positive impact
on the Adam's health (Sun, (2017)).
Nursing Management- In this, intervention, there is need to focus on the delivery of
hlae4thcare and treatment that plays crucial role in providing care towards the clinical activity.
They have the role to take care of the patient which can help through getting ensure about the
right medication and should ensure about taking them on time with proper dose. This allows to
take care of the patient which can be possible by helping through the nursing staff. Nursing staff
are available to help in performing daily activity and provide help in effective monitoring
regarding patient health. Nursing staff have the ability to take care of the patient in effective way
that can help to avoid the chance of getting worse health of patient. There is need to focus on the
delivery of time to time evaluation that can provide information about the patient's health
condition (Seo, (2019)).
CONCLUSION
From above discussion, it can be concluded that there are various sign and symptom
through which patient have worse health condition in which getting cold and cough are the two
reason which should be diagnosed. There are many of the clinical priorities which are necessary
for the diagnosis. There is need to focus on the intervention which can have impact on the better
delivery of healthcare treatment. There is two different intervention has been chosen in which
one is related with pharmacological agents and other is nursing management where each includes
role of nursing staff.

REFERENCES
Books and Journals
Appavu, (2019). Clinical trials for pediatric traumatic brain injury: definition of insanity?:
JNSPG 75th Anniversary Invited Review Article. Journal of Neurosurgery:
Pediatrics, 23(6), 661-669.
Daverey, (2020). Curcumin protects against white matter injury through NF-κB and Nrf2 cross
talk. Journal of neurotrauma, 37(10), 1255-1265.
Dos Santos, (2020). Oral mucosal lesions in a COVID-19 patient: New signs or secondary
manifestations?. International Journal of Infectious Diseases, 97, 326-328.
Pacella, (2020). Combined vEEG and Cerebral Oximetry Results to Determine the Severity of
Hypoxic–Ischemic Encephalopathy. Journal of Pediatric Neurology, 18(02), 079-087.
Preeti, (2019). Anthropometric measures as biomarkers of neurodevelopmental outcomes of
newborns with moderate to severe hypoxic ischemic encephalopathy. Journal of
neonatal-perinatal medicine, 12(2), 127-134.
Seo, (2019). Effect of hypoxia on mortality and disability in traumatic brain injury according to
shock status: a cross-sectional analysis. The American journal of emergency
medicine, 37(9), 1709-1715.
Sun, (2017). Effect of hyperbaric oxygen therapy on BI index, GCS, SAS and SDS in patients
with craniocerebral injury. Journal of Hainan Medical University, 23(16), 130-133.
Yang, (2021). Verification of particle matter generation due to deterioration of building
materials as the cause of indoor fine dust. Journal of Hazardous Materials, 416, 125920.