Patient Information
The patient here is Mr. Trevor Wilkins, who is a 37 years old male who is being attended by a registered nurse, Jess for his leg ulcer. His leg ulcer has not been healing. While he was intoxicated, the patient suffered a fall. The past clinical history of the patient shows that he has been suffering from type 1 diabetes mellitus. He is a social drinker. There is also no record of any drug allergies that is known. On examination of the vitals of the patient, the results were as followed: HR 112, BP 98/58, RR 18, T 37.6, SpO2 99%. The weight was 97kg. The height of the patient was 167cm and the Blood Glucose Level was 13.6mmol/L. The patient is comfortable with doing the activities of daily life independently. On examination the registered nurse found out that his wound area had turned red and there was slight odour in the wounded area. Mr. Wilkins lacked family support since he had no close family or friends.
For this case, the health assessment framework used is the National Clinical Assessment Framework (Attard, Baldacchino & Camilleri, 2014). The framework comprises of the following aspects which are as follows:
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Areas |
Aspects of performance |
|
Preliminary health check |
HR 112, BP 98/58, RR 18, T 37.6, SpO2 99%. The weight was 97kg. The height of the patient was 167cm and the Blood Glucose Level was 13.6mmol/L |
|
Comprehensive health and developmental assessment |
The wound area of the patient had turned red and there was slight odour in the wounded area. It was perceived that Mr. Wilkins lacked family support since he had no close family or friends. His past clinical history of the patient shows that he has been suffering from type 1 diabetes mellitus. |
|
Ongoing, age appropriate assessments and health monitoring |
The patient is comfortable with doing the activities of daily life independently. However he needed care from the registered nurse regarding his leg ulcer, which had not been healing from a long time. |
In accordance to this framework the normal finding were that that patient was independent enough to perform his activities of daily life. His vitals were also under control. However he was a little obese as perceive by his body mass index. The abnormal findings were that he was diabetic as shown by his blood glucose level results. His leg ulcer had not been healing now for a long time. Additionally his wound area has now turned red and there was odour discharging from the area. He lacked any emotional support from his family and friends hence had no support.
After the registered nurse conducted a focussed assessment on the patient, she identified several problems that were evident with the patient. One of the major problems was the leg ulcer which was not healing in spite of the ongoing treatment, additionally the wound area was becoming red and odour was discharged from the area. The next problem was his medical history of type 1 diabetes mellitus. Finally he suffered from social isolation as he lacked ant support from close family or friends.
The open ended questions that were asked to the patient are as follows:
For leg ulcer:
When was the first signs and symptoms of the ulcer occur?
What do you think caused the ulcer?
How long have you been on medication for this problem?
For type 1 diabetes mellitus:
How long have you been suffering from the disease?
When was the first signs and symptoms of diabetes occur?
What medication are you right now in order to control the type 1 diabetes mellitus?
Social isolation
Do you have any immediate family?
If yes, where are they?
What has made you distant from your family and friends?
In order to assess leg ulcers, the following interventions might be implemented:
- Taking the full medical history of the patient
- Enquiring about the lifestyle of the patient
- Observe the leg and skin appearance
- The peripheral pulses needs to be detected. Certain assessment needs to be carried out in terms of ABI, pain, typical location of the wound, appearance of the wound bed, shape of the wound and its depth, the exudates of the wound and finally the peri-wound appearance.
- In orde to detect and understand the type 1 diabetes mellitus on a patient completely, certain diagnostic tests needs to be performed. These includes the Glycated hemoglobin (A1C) test, along with random blood sugar test and the fasting blood sugar test. The Glycated hemoglobin (A1C) test is useful in indicating the average level of the blood sugar. It detects the percentage of the attached blood sugar to the haemoglobin. In case the A1C level is 6.5 percent or higher then it indicates presence of diabetes. In case of fasting blood sugar level, if it is less than 100 mg/dL (5.6 mmol/L) the results are normal. If the fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) then it is considered as prediabetes. Finally if it’s 126 mg/dL (7 mmol/L), then the patient is confirmed having diabetes (Tallis et al., 2013).
- In order to detect loneliness, the CEL’s 2015 guidance can be used. This comprises of three 3-question scale in addition to the Giervald 6-question scale along with the UCLA 3-question scale and single-item scales. In case of social isolation, Duke Social Support Index (DSSI) can be used along with Lubben Social Network Scale (LSNS). The Social Disconnectedness can also be implemented in this case (Weber & Kelley, 2013).
National Clinical Assessment Framework
With the increase of acuteness of the condition of a patient, it becomes very important for the nurses to prioritise the care of the patients. The assessments conducted by the nurses needs to be built on a priority based setting that will highlight the skills of the qualifying nurses. Observation conducted by the nurses on the patients aim to monitor the progress of the patients and to ensure the rapid detection of the evens that might have an adverse effect on the recovery of the conditions of the patients. In the context of nursing triage, it is perceived that the nurses assesse the patients initially and the priority of the order is involved in which they are perceived by the clinical staff. According to the guidelines provided by the Australian Commission on Quality and Safety in health care, 2012 and the Nursing and Midwifery board of Australia, 2016, it is expected that the nurses should be effectively proactive while undertaking medical assessment (Rooke, 2014). It is the job role of the nurses to ensure that the initial examination is being carried out accurately. This is true especially in cases of wounds where the nurses have to properly examine the wound and decide which type of dressing is required for the particular wound. The nurses are also pivotal while carrying out the fall assessments. There is a requirement of proper physical assessment along with the development tissues and training which needs to the addressed appropriately. In case of respiratory assessments, there is a scope of the nurses to expand their practise. Basic assessments are required which needs to be conducted appropriately (.Kleinpell, 2013)
While the nurses conduct health assessments on an individual, there is a requirement for significant knowledge and data collection techniques that might be subjective as well as objective data. It includes the facts the patients say about themselves along with data collected from the physical assessments and inspection of the conditions along with percussion and palpation occurring during the examination. It is evident from literature that if the data collected through these assessments are incorrect it might lead to wrong diagnosis which in turn might end up with wrong treatment of the patient. The guidelines of the Nursing and Midwifery Council (NMC) (2002), urges all nurses involved in medical assessments to play their job role in a professional manner (Kitson et al., 2013). They should abide by the policies that is set out by the organization they work in. This should be followed in accordance to the Code of Professional Conduct. Additionally the code of conduct suggests that the nurses should be involved in proper recording and documentation of the information that is acquired through the assessment of the patients. Inn case of any deviation from the actual results, there might be potential consequences. According to the guidelines, the health assessment should follow the purpose of making a call of judgement or diagnosis since most of the decisions are based on the data that are collected during assessment. It is important that there is accurate and complete assessment conducted before making a final clinical decision (Hemingway et al., 2013). The assessments should focus on the needs of the patients at the time of examination. The assessment should be accurate and fair in terms of the individual and the life of the individual. The aim of overall assessment should be to delve deeper into the patient’s illness and preventing more problems from arising
References
Agale, S. V. (2013). Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers, 2013.
Attard, J., Baldacchino, D. R., & Camilleri, L. (2014). Nurses’ and midwives’ acquisition of competency in spiritual care: A focus on education. Nurse Education Today, 34(12), 1460-1466.
Garside, J. R., & Nhemachena, J. Z. (2013). A concept analysis of competence and its transition in nursing. Nurse Education Today, 33(5), 541-545.
Giger, J. N. (2016). Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health Sciences.
Grilo, A. M., Santos, M. C., Rita, J. S., & Gomes, A. I. (2014). Assessment of nursing students and nurses’ orientation towards patient-centeredness. Nurse Education Today, 34(1), 35-39.
Hemingway, H., Croft, P., Perel, P., Hayden, J. A., Abrams, K., Timmis, A., … & Roberts, I. (2013). Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes. Bmj, 346, e5595.
Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient?centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of advanced nursing, 69(1), 4-15.
Kleinpell, R. M. (Ed.). (2013). Outcome assessment in advanced practice nursing. Springer Publishing Company
Pettit, T. J., Croxton, K. L., & Fiksel, J. (2013). Ensuring supply chain resilience: development and implementation of an assessment tool. Journal of business logistics, 34(1), 46-76.
Rooke, N. (2014). An evaluation of nursing and midwifery sign off mentors, new mentors and nurse lecturers’ understanding of the sign off mentor role. Nurse Education in Practice, 14(1), 43-48.
Tallis, A., Motley, T. A., Wunderlich, R. P., Dickerson Jr, J. E., Waycaster, C., Slade, H. B., & Collagenase Diabetic Foot Ulcer Study Group. (2013). Clinical and economic assessment of diabetic foot ulcer debridement with collagenase: results of a randomized controlled study. Clinical therapeutics, 35(11), 1805-1820.
Weber, J. R., & Kelley, J. H. (2013). Health assessment in nursing. Lippincott Williams & Wilkins.
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