'Assessment and Care Planning: Holistic Assessment\r'

'Introduction\r\nThis essay deals with the holistic perspicacity of a enduring of who was admitted onto the medical checkup exam ward where I undertook my placement. Firstly, the relevant animateness invete footsteple of the colossal-suffering entrust be briefly explained. Secondly, the Roper, Logan and Tierney lesson of business organisation for that was apply to assess the billing ask of the patient of will be discussed, and then the mind process will be analysed critically. Identified aras of have will be discussed in relation to the apportion given(p) and with reference to psychological, social, and biological factors as easy as patho-physiology. Further much(prenominal), the role of inter-professional skills in relation to guard planning and de travelry will be analysed, and ultimately the occupy given to the patient will be evaluated.\r\nThrough prohibited this assignment, confidentiality will be confirmed to a high standard by following the breast feeding and Midwifery Council (NMC) encrypt of Conduct (2008). No entropy regarding the hospital or ward will be mentioned, in accordance with the Data Protection exhaustively turn 1998. The pseudonym Kate will be make use ofd to maintain the confidentiality of the patient.The PatientKate, a lady get ond 84, was admitted to a medical ward through the Accident and Emergency de partingment. She was admitted with asthma and a government agency infection. She presented with severe dyspnoea, take a breather, chest immersion and immobility. Kate is a patient known to suffer from chronic chest infections and asthma, with which she was diag jabd when she was young. She takes regular bronchodilators and corticosteroids in the form of inhalers and tablets. Kate lives on her own in a one bedroom flat. She has a daughter who lives one street remote and visits her frequently. Her daughter state that Kate has a really alert social life; she enjoys spillage out(p) for shop using a shopping trolley. judicial decision of the PatientAssessment TheoryIn this ward, the Roper, Logan and Tierney pretense of nursing, which reflects on the cardinal activities of living, is used as a tooth root for assessing patients (Alabaster 2011). These activities are â€Å"maintaining safe surroundings, colloquy, suspire, eating and drin a race(predicate)g, elimination, in the flesh(predicate) groom and dressing, controlling body temperature, mobility, working and playing, sexuality, sleeping, and dying” Holland (2008, p.9).\r\nElkin, Perry and ceramist (2007) outlined nursing process as a systematic way to plan and deliver business concern to the patient. It involves four stages: estimation, planning, implementation and evaluation. Assessment is the first and near critical step of the nursing process, in which the sustain carries out a holistic estimate by collecting all the data nigh a patient (Alfaro-Lefevre 2010). The take for uses physical sagacity skills to welcome baseline data to manage patients’ problems and to benefactor halts in the evaluation of portion out. Data can be dispassionate through watching, physical assessment and by interviewing the patient (Rennie 2009). A complete assessment produces both infixed and objective findings (Wilkinson 2006). Holland (2008) de gracefuls subjective data as pedagogy given by the patient. It is obtained from the health history and relates to sensations or symptoms, for illustration pain. Subjective data alike includes biographical data such as the name of the patient, address, succeeding(a) of kin, religion etc. Holland defines objective data as observable data, and relates it to signs of the disease. Objective data is obtained from physical examination, for example of bank line prescertain(p) or urine.\r\nBefore assessment takes place, the withstand should explain when and why it will be carried out; allow adequate condemnation; watch to the ineluctably of the patient; consider confidentiality; ensure the environment is conducive; and consider the coping dominions of the patient (Jenkins 2008). The nurse should also introduce herself to uphold reduce solicitude and gain the patient’s confidence. During assessment, the nurse inevitably to use both verbal and non-verbal communication. Using non-verbal communication means that she should observe the patient, looking at the coloration of the skin, the eyes, and taking note of odour and cellular respiration. An accu localise assessment enables nursing staff to prioritise a patient’s rents and to deal with the problem nowadays it has been identified (Gordon 2008). Documentation is also actually master(prenominal) in this process; all information placid has to be recorded either in the patient’s file or electronically (NMC, 2009b).Carrying out the AssessmentKate was allocated a bed within a four-bed effeminate bay. Her daughter was with her at the bedside. G ordon (2008) stated that understanding that whatever admission to hospital can be fright for patients and allowing them some succession to get used to the environment is measurable for nursing staff. Kate’s daughter was asked if she could be present trance the assessment was carried out, so that she could help with some information, and she agreed. Alfaro-Lefevre (2008) recommended that nursing assessments take place in a sepa assess room, which respects confidentiality, and that the patient be free to participate in the assessment. Although there was a room available, Kate’s daughter say it was fine for the assessment to take place at the bedside because her fuck off was so restless and just wanted to be next to her. The curtains were pulled around the bed, though William and Wilkins argued that it ensures visual covert only and not a barrier to sound. NMC (2009a) acknowledges this, on with the need to speak at an appropriate the great unwashed when asking f or personal dilate to maintain confidentiality.\r\nThe assessment form that was used during Kate’s assessment turn to personal details and the twelve activities of living. A go and handling assessment form was also effected because of her immobility. First, personal details such as name, age, address, nickname, religion, and lodgment status were recorded. Information was also recorded somewhat any agency involved, a coarse with next of kin and contact details, and details of the general practitioner. Holland (2008) stated that these details should be accurate and legible so that, in case of any concerns about the patient, the next of kin can be contacted easily. The name and age are also zippy in enjoin to mightily identify the patient to avoid mistakes. Knowing what fictional character of a job the patient does or the typeface of the house she lives in helps to suggest how the patient is going to cope afterward discharge. Holland also insisted that religion shou ld be known in case the patient would corresponding to have some retirement during prayers, and this should be include in the deal out plan.\r\nThe second assessment to be done focused on physical assessment and the activities of living. Barrett, Wilson and Woollands (2009) suggested that when enquiring about the activities of living, two elements should be addressed: mutual and current routines. Additionally, identifying a patient’s habits will help in care planning and background signal goals. During physical assessment, when objective data was collected, Kate demonstrated backbreaking and audible breath sounds (wheezing) and breathlessness. Use of accessory muscles and nose flaring was also noted. She was agitated and anxious. Her vital signs were: blood pressure 110/70; pulse 102 beatniks /min; respirations 26/min; temperature 37.4 degrees Celsius; type O vividness 88%; peak flow 100 litres; system of weights 60kg; and body mass index 21. Taking and transcription observations is very grave and is the first procedure that student nurses learn to do. These observations are made in align to detect any signs of deterioration or senesce in the patient’s condition (Field and smith 2008). Carpenito-Moyet (2006) stated that it is Copernican to take the first observations onwards any medical intervention, in order to swear out in the diagnosis and to help assess the cause of treatment.\r\nKate’s sign assessment was carried out in a professional way, taking account of the patient’s particular circumstances, anxieties and wishes. After the baseline observations were taken, the twelve activities of living were analysed and Kate’s needs were identified. Among the needs identified, suspire and personal hygienics (cleansing) will be explored.Identified bearing NeedsBreathingWilkinson (2006) states that a nursing diagnosis is an account about the patient’s current health situation. The practice lively rate i n a transcend short adult is 16-20 respirations/minute, but can go up to 30 due to pain, anxiety, pyrexia, sepsis, sleep and old age (Jenkins 2008). In old people, muscles become less good, resulting in increasing efforts to breathe, causing a high respiratory rate. On assessment, Kate’s problem was breathing that resulted in insufficient intake of short letter, due to asthma. She was wheezing, cyanosed, anxious and had gruffness of breath.\r\nWilkinson (2006) explained that a goal statement is a quantitative and noticeable criterion that can be used for evaluation. The goal statement in this case would be for Kate to maintain ordinary breathing and to increase air intake. The prescription of care for Kate depended on the assessment, which was achieved by monitor her breathing rate, rhythm, pattern, and loudness take aims. These were documented hourly, comparing the readings with initial readings to determine changes and to report any concerns. The other part of the plan was to give psychological care to Kate by involving her in her care and informing her about the progress, in order to reduce anxiety. Barrett, Wilson and Woollands (2012) stated that it is very important to give psychological care to patients who are unventilated because they panic and become anxious.\r\nChecking and recording of breathing rate and pattern is very important because it is the only heavy way to assess whether this patient is improving or deteriorating, and it can be a very useful method for nurses to evaluate whether or not the patient is responding to treatment (Jamieson 2007). Mallon (2010) stated that, if the breathing rate is more than 20, it indicates the need for oxygen. Blows (2001), however, argued that this can happen even after doing exercise, not only in people with respiratory problems. Griffin and Potter (2006) stated that, respirations are commonly quiet, and therefore if they are audible it indicates respiratory disease. Nurses needs to be awa re of these sounds and what they mean, for example a wheezing sound indicates bronchiole constriction. Kate’s breathing was audible and the rate was also above normal and that is why breathing was prioritised as the first need.\r\nOxygen saturation level was also monitored with the use of a pulse oximeter. The normal saturation level is 95-99% (British National pharmacopeia ((BNF)) 2011a). all the same the doctor said that 90-95% was fine for Kate, considering her condition and her age. Kate was started on two litres of oxygen and she maintained her oxygen saturation between 90 and 94%. The peak expiratory flow was monitored and recorded to identify the obstructive pattern of breathing that takes place in asthma (Hilton, 2005). This is some other method that is used to assess the effectiveness of the medical specialty (inhalers) the asthmatic patient is taking, and this test should be carried out 20 minutes after medication is administered. It is the self-confidenceâ€⠄¢s policy to do hourly observations on patients who have had one, two or three abnormal readings, until readings return to normal. Kate was observed for any blueness in the lips and tongue and for oral mucosa as this could be a sign of cyanosis. All the prescribed nebulisers, inhalers, bronchodilators, corticosteroids, antibiotics and oxygen therapy were administered according to the doctor’s instructions. Bronchodilators are given to dilate the bronchioles constricted due to asthma, and corticosteroids reduce hullabaloo in the airway (BNF 2011b). Kate was also started on antibiotics to fight the infection because, on auscultation, the doctor found that the chest was not clear.\r\nKate was nursed in an upright grade using pillows and a profiling bed in order to increase chest capacity and help oneself easy respiratory function by use of gravity (Brooker and Nicol, 2011). In this position, Kate was comfortable and calm while other vital signs were being check up on. Pul se rate and blood pressure were also being check and recorded because raised pulse can indicate an infection in the blood.CleansingDue to breathlessness and loss of mobility it was impediment for Kate to maintain her personal hygiene. Hygiene is the practice of cleanliness that is demand to maintain health, for example bathing, mouth washing and bull washing. The skin is the first line of defence, so it is vital to maintain personal cleansing to protect the intragroup organs against injuries and infection (Hemming 2010). Field and smith (2008) stated that personal cleansing also stimulates the body, produces a thought of well-being, and enables nurses to assess the patient holistically. Personal hygiene is oddly important for the elderly because their skin becomes fragile and more prone to breaking down (Holloway and Jones 2005). Therefore this need was very important for Kate; she unavoidable to maintain her hygiene as she used to, before she was ill.\r\nThe goal for come across this need was to maintain personal hygiene and comfort. The care plan prescribed involved first gaining coincide from Kate, explaining what was going to be done. Hemming (2010) recommended that identifying the patient’s regular habit is very important because each one-on-one has different ideas about hygiene due to age, market-gardening or religion. Identifying usual habits helps individuals to maintain their social life if things are done according to their wishes. Though Hemming said all human beings need personal hygiene, Holland (2008) argued that it is important to ask patients how they feel about being cleaned, specially in private areas. Kate indicated that she didn’t mind being support with washing and dressing. She preferred washing daily, rain shower and a hair wash once a week, and a mouth wash every aurora and before going to bed.\r\nKate was assisted with personal care 5-10 minutes after having her medication, especially the nebuliser. Ind ividuals with asthma exist shortness of breath whenever they are physically busy (Ritz, Rosenfield and Steptoe 2010). After having medication Kate was able to participate during personal hygiene. According to NMC guidelines on confidentiality (2009a), privacy and dignity should be maintained when giving care to patients. Therefore, whenever Kate was being assisted with personal care, it was ensured that the screens were closed and she was properly covered. Field and Smith (2008) suggested that assisting a patient with personal hygiene is the time that nurses can assess the patient holistically. Since Kate was immobile, it was very important to check her pressure areas for any redness. She was also checked for any pallor, jaundice, cyanosis or dry skin that needed attention. The care was always carried out according to her wishes.The place of Inter-Professional SkillsConsidering Kate’s age and condition, she needed multi-professional aggroupwork. NMC (2008) encourages team work to maintain good quality care. Kate was referred to the respiratory nurse who is specialised in helping people with breathing problems. Since Kate was on oxygen since admission, the respiratory nurse taught her the grandeur of healthy breathing and taught her some breathing exercises to help wean her from oxygen. Kate was also referred to the physiotherapist who did breathing exercises with her. Kate was not able to strait without aid so she was also referred to the occupational therapy subdivision to assess how she was going to manage at crime syndicate, or if she required aids to help her manage the activities of living. Upon clash together, all the multi-disciplinary team agreed that Kate needed a care package, as she could no longer live without care. She was referred to social services so that they could assess this flavour of Kate’s future.\r\nAfter one week Kate was medically fit but could not go bag because she was waiting for the care package to be ready. Her nurse shared information with the multi-disciplinary team in order to establish continuity of care for Kate. The team lively for her discharge: the occupational therapy staff went to visit her home to check if there was enough space for her walk frame; social services arranged for a care package; and her nurses referred her to the district nurse to help her with her medication and make sure it did not run out.OutcomeKate responded well to the medication she was prescribed; normal breathing was maintained, her respirations became normal, ranging from 18 to 20 respirations per minute, and her oxygen saturation ranged from 95% to 99%. Kate was able to wash and dress herself with stripped-down assistance. She was discharged on a continuous care package comprising care three times a day, and the district nurse helped her with the medication to control her asthma.EvaluationThe model of the twelve activities of living was followed success in full on the whole. The nurse collected s ubjective and objective data, allowing a nursing diagnosis to be formulated, goals to be identified and a care plan to be constructed and implemented. Privacy is very important in carrying out assessments, and this was not achieved fully in Kate’s assessment. However, this lower level of privacy has to be balanced against causing anxiety to the patient. Kate’s daughter thought that the bedside assessment would be more comfortable for her mother, and therefore cause least anxiety. This was very important because of the effects of potential panic on breathing; therefore, this was the correct balance to strike.\r\nA multi-disciplinary team was involved in meeting Kate’s care goals. This is a good example of the use of inter-professional skills, as a number of different departments were involved in creating and implementing the care plan. However, the system was not as efficient as it should have been: Kate spent unnecessary time in hospital after recovery because t he care plan was not yet in place.\r\nAssessment can also take a long time, especially with the elderly who are usually dimmed to respond. Therefore, more time is needed to be sure that the necessary progress has been achieved before taking farther steps. However, poor staffing also affects performance in this area, an observation supported by the gallant College of breast feeding (2012).\r\nIn conclusion, the assessment of this patient was completed successfully, and the deviation from beaver practice recommendations (the lower level of privacy) was justified by the clinical circumstances. Progress from assessment to care goals was good, and at this point an inter-disciplinary team was used successfully. However, the one taint in this process was delays, caused partly by the difficulties of working across different departments, and partly, it seems, by staff shortages.\r\n cite List\r\nAlabaster, C.S (2011) ‘ bearing and rehabilitation of people with long term conditionsà ¢â‚¬â„¢ in Brooker, C. and Nicol, M. (eds) (2011) Alexander’s nurse Practice (4th ed). capital of the United Kingdom: Churchill breathingstone.. Chapter 32\r\nAlfaroâ€LeFevre, R. (2008) Critical thinking and clinical judgment: A practical speak to to outcome-focused thinking (3rd ed.). St. Louis, MO: Saunders.\r\nBarrett, D., Wilson, B. and Woollands, A. (2009) Care Planning: A Guide for Nurses (2nd ed). Harlow: Pearson Education. Chapter 2.\r\nBlows, W. T. (2001) The Biological Basis of care for: clinical Observations. capital of the United Kingdom: Routledge.\r\nBritish National Formulary (2011a) Oxygen. capital of the United Kingdom: British Medical Association and the Royal pharmaceutic Society of Great Britain.\r\nBritish National Formulary (2011b) Corticosteroids. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain.\r\nBrooker, C. and Nicol, M. (eds) (2011) Alexander’s nurse Practice (4th ed). London: Churchill Liv ingstone.\r\nCarpenito-Moyet, L. J. (2006) Handbook of treat Diagnosis (11th ed). Philadelphia: Lippincott.\r\nDoughty, L. and Lister, S. 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Available at:\r\nhttp://www.rcn.org.uk/__data/assets/pdf_file/0010/439399/Safe_staffing_for_older_people_V3.pdf Accessed: 24/05/2012\r\nWilkinson, J. M. (2006) Nursing Process and Critical Thinking. (4th ed). New jersey: Pearson Prentice Hall.\r\n'