Nursing Care: Assessment, Interventions for Deteriorating Patient

This report provides a comprehensive analysis of a deteriorating patient's case, focusing on the assessment of the patient's condition, including vital signs, neurological status, and medical history. The report outlines the concerns related to the patient's presentation, such as blank expressions, absent-mindedness, and physical weakness, considering the patient's age and existing health conditions like Type 2 diabetes and hypertension. It details the rationale behind various assessments and interventions, emphasizing the roles of nurses and general practitioners in understanding the patient's collapse and ongoing care. The report also develops a detailed care plan, including both nurse-initiated and collaborative interventions, with a focus on providing culturally safe and holistic care. This includes the assignment of a male nurse, dietary plans, and creating a simplified environment. The report concludes with a personal evaluation of progress, highlighting the importance of ongoing monitoring and patient-centered care. References to relevant literature are included to support the report's findings and recommendations.

THE DETERIORATING PATIENT

TABLE OF CONTENTS
Outline the issues and concerns...................................................................................................1
Discuss assessments and interventions appropriate for this client with rationale, ensure you
stay relevant to your clinical area and are culturally safe ...........................................................1
Care plan and provide a rational for each nursing action............................................................2
Personal Evaluation of progress...................................................................................................3
REFERENCES................................................................................................................................5

Outline the issues and concerns
In regard to the concerns, the blank expressions and absent mindedness while saliva was
drooling from his mouth are directly indicating towards the ailing conditions. His erratic
conditions of heart and his ailing age would also increase the time of recovery (Kutzleb, Duran
& Flynn, 2015). It also requires to understand that he was brought top the hospital after collapse
which shows poor oxygenation levels and signs of fatigue and weakness. The vital signs
recorded in the early hours of morning defines the flags in terms of acquiring the nearby places
of normal range. For instance, the BP levels is also above the normal range and thus, it has also
increased the deteriorating levels of Orkins.
Moreover, the issues involve Orkin's strength component where its upper and lower
extremities in the right side comes under 3/5 and the upper and lower extremities on the left side
for 4/5. With the GCS of 13, it was shown that he is undergoing mild levels of coma and must be
given assistance while conducting tasks or performing daily chores. Despite this, the patient was
reluctant in attending to the needs of personal hygiene and it might be due to the presence of
female nurse (Webster, Ekers & Chew-Graham, 2016). This also led to know the discomfort he
felt while being at hospital.
Rationale for assessments and interventions
The process for conducting assessments included about role of professionals like nurses
and general practitioners to know the reason behind the collapse (Arakaki, Uehara & Gushikawa,
2016). It shed light on noting down about medication including diamicron of 80 milligrams to be
taken daily, simvastatin of 20 milligrams in evening and amlodipine of 5 milligrams in morning.
In addition, it also highlighted the admission time when he was observed overnight. It included
about his unresponsive attitude for brief time, went to use wash rooms twice and absence of
bowels. However, later in morning, he looked little lost and was lying on the right side in slumpy
way. He also had slurry speech and saliva was drooling which signifies towards the absent
mindedness. Alongside, urine odour was prevalent and was strongly presented.
Here, the rationale includes conducting interventions that is beneficial to nursing, it was
seen that primary and secondary assessments are important to include. For e.g. his heart rate is
normal as 98 bpm. The oxygenation levels is nearby the normal levels between 95 and 100 %
and has been recorded as 93 % that clearly defines the poor blood oxygenation. Additionally, the
nurses easily take stats and maintain cordial relations to know the progress. For instance,
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respiratory rate has been noted as 24 bpm which is abnormal and it outlines the fact that his heart
is not functioning in proper manner. However, no pain was voiced through.
Furthermore, it helps nurses to measure Orkin's sugar levels were 10.4 mmol/mL which
helped in assessing the dangerous levels of sugars who has already Type 2 diabetes. Such
focused assessments involved the neurological assessment where this elderly patient scored 13
on the Glasgow Coma Scale. This has been represented with the E4V3M6 and this demonstrated
that it has mild coma. This shows that eye opening has reaction with right eye size of 4 and left
eye size is 2 and verbal responses with motor responses. Thus, his conditions are clearly not
stable and is leading towards several risks and challenges in performing tasks and do the daily
chores without any efforts.
Care plan and provide a rational for each nursing action
The nursing interventions are essential in treating patients under professional
guidance and provide the platform of culturally safe and holistic approach ( Chrvala, Sherr&
Lipman, 2016). Mr. Orkins is an 84 years old man who collapsed at one of his relatives
home in Sydney when he came with his wife to visit. He has a medical history of Type
2 diabetes mellitus, hypertension and hyperlipidaemia.
The CARE PLAN includes assigning a male nurse permanently to assist Orkin
in performing daily chores and take medication properly under professional guidance
(Verloo, Kampel & Santschi, 2017). Moreover, this plan highlights a proper diet with
organized schedule to make him recover from the slurriness and blankness he had been
facing due to ageing. The assigned nurses would be adopting nurse initiated and
collaborative nursing interventions to make Mr. Orkin better and healthy. Also, the emphasis
is on making the environment simplified and productive to bring positivity in his life ( Pan, Shi
& Fang, 2019 ). Their participation must be encouraged through open channels of
communication.
Herein, Nurse initiated intervention is involved on the systematic guide for
improvising the patient centred care. The focus is on diagnosing, planning, executing and
monitoring every detail for elderly patients like Orkin (Butcher, Dochterman & Wagner, 2018).
This is that intervention that is associated with the single stage planning and included the nurses'
participation through design the recovery and treatment plan in accordance to the observatory
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changes on daily basis. They have the authority to give guidance about the causes and checking
the vital signs to inform the professionals. The nurse associated in this type helps in creating
quality and delivery of services to execute the nursing care plan.
Next is collaborative nursing intervention is that intervention that assist the nurses
in taking help of multi disciplinary team. This is refereed as the interdependent type of
intervention where the emphasis is on imparting good training to create an atmosphere of
trust, reliability and transparency ( Gok Metin, Ozdemir & Arslan , 2017) . Moreover, the objective
is to educate each individual associated with specific case and keep in ouch to inform about
every change or modification for the betterment and well being of patients.
Personal Evaluation of progress
It has been identified that this patient is undergoing deteriorating situation and I learnt
that he required assistance to know about the ongoing activities. However, his reflexes are good
and he only goes into blank expressions but it has been found out that he might not be able to
respond properly all the times. Thus, I constantly monitor the vitals and check the symptoms on
regular basis to give interactive patient centred care.
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REFERENCES
Books and Journals
Arakaki, M., Uehara, K., & Gushikawa, H. (2016). The feasibility of nurse intervention to
improve and maintain the BMI of breast cancer survivors over 25 to appropriate levels.
Butcher, H. K., Dochterman, J. M. M., & Wagner, C. (2018). Nursing Interventions
classification (NIC)-E-Book. Elsevier Health Sciences.
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for
adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic
control. Patient education and counseling. 99(6). 926-943.
Gok Metin, Z., Ozdemir, L., & Arslan, I. E. (2017). Aromatherapy massage for neuropathic pain
and quality of life in diabetic patients. Journal of Nursing Scholarship. 49(4). 379-388.
Kutzleb, J., Duran, D., & Flynn, D. (2015). Nurse practitioner care model: meeting the health
care challenges with a collaborative team. Nursing Economics.33(6). 297.
Pan, M., Shi, R., & Fang, H. (2019). Nursing Interventions to Reduce Peripherally Inserted
Central Catheter Occlusion for Cancer Patients: A Systematic Review of
Literature. Cancer Nursing.
Verloo, H., Kampel, T., & Santschi, V. (2017). Nurse interventions to improve medication
adherence among discharged older adults: a systematic review. Age and ageing. 46(5).
747-754.
Webster, L. A., Ekers, D., & Chew-Graham, C. A. (2016). Feasibility of training practice nurses
to deliver a psychosocial intervention within a collaborative care framework for people
with depression and long-term conditions. BMC nursing. 15(1). 71.
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