Managing Complex Clients

Introduction to Coroner

Coroner is an employee who is generally appointed from the government side, to inquire about the manner or the cause of death of an individual in a hospital setting (Ibrahim, 2019). The given case scenario is of a 3-year-old child who was admitted to the healthcare setting post having an upper respiratory tract infection. He got relived of his symptoms and was again re-admitted due to an underlying left lower lobe pneumonia associated with hypernatremia. The critical essay will help in identifying the gaps in the treatment of the patient in respect with the turn of events mentioned as per the given case study. The essay will also help on highlighting the point as to how these faults can be used as a learning for future inferences, to minimize the risk associated with patient treatment and management.

Recognition and Response to Deterioration in Complex Patients

It is imperative to identify for the early adverse signs and symptoms in the patients. This will be helpful in evaluating the course of further action that is required in the patient care and management. By early detection of adverse signs and symptoms, early preventive measures can be taken, within the given time frame (Massey, 2017). This is also vital in terms of prevention complication in patients by multiple fold, post their recovery. Due to delay in action taking with the required measures, a patient is liable to have multiple complications including, cardiovascular, renal, and neurological and so on. These complications can also be responsible for leaving the patient with some extent of mental as well as physical deficit. These signs are a direct indicator of the patients’ deteriorating clinical status and identifying them promptly and with good clinical judgment is very crucial.

The signs can be identified by the nurses or any healthcare staff, which is qualified enough and is working in close contact with the patients, in providing them with the required care and treatment management (Chua, 2019). It is also vital from the point of improving the anticipated clinical outcomes in the patient. By early identification and prevention of the same, the patient can be relived off the unnecessary burden that can be bored on maintaining his physical as well as mental stress, post recovery. Improved healthcare outcomes are very necessary from the point of view of attaining improved quality of life as well. This will also be good for promoting an independent status of living in the patient and thus, instilling his faith and confidence in his recovery. The good health status will also be beneficial to maintain a good mental status in the patient, thus, enabling him to attain higher treatment goals with improved outcomes (Treacy, 2019).

Case Study Evaluation: Managing Complex Clients

The patient in the given case study was initially admitted to the hospital with an episode of worsened cough. He was manages with certain antibiotics for his upper respiratory tract infection which was diagnosed by the doctor. Although the cough seemed to be subsided but the patient went on to have loose stools due to which he was unable to complete the course of his antibiotics. Due to increased adverse symptoms patient was shifted to another care facility for further management. In the second setting the patient underwent both blood as well urine sample collection to determine for the underlying cause of his infection spread. The patient was dully managed with fluid therapy as there was an obvious sign of dehydration noted in the patient. Fluid management therapy helps in restoring the fluid balance in the body and is very helpful to maintain the electrolyte balance as well (Malbrain, 2018). This helps in preventing muscle fatigue and depression in physical status of the patient. This therapy is also useful for maintaining blood pressure in the patient, which was also needed in the study as the patient was noted with dipped blood pressure reading as well.

Patient also reported with decreased peripheral perfusion and therefore, bolus of normal saline was also provide to the patient. Patient is also in a severe respiratory deficit and is thus, being managed by oxygen therapy. The decision was dully made as the patient was having a decreased air entry in the lower passages of the lungs. This structures are the most important one to take part in the respiratory exchange and help in maintaining lung patency as well. However, managing patients with just position management as well as oxygen therapy is not sufficient in such cases (Pardue, 2016). The patient is also having an underlying infection in cognition with the respiratory insufficiency, therefore, blood culture for specific agent causing the infection should also be evaluated for noting the underlying causative agent for causing infection. The pneumonia of the patient in the case study was noted secondary to viral or bacterial infection. Throughout the treatment management however, no efforts were made to identify for the infection causing organism. The patient throughout the management had signs of swelling and presence of edema in the body. He had puffy eyes as well had an urge to pass urine, even with the catheter intact.

The patient was also having a fluid overload. The patient was very well managed with fluid therapy and was not having sufficient urine output. The patient could have been provided with diuretics to manage the urine output (Murphy, 2019). Due to reduced filtration the patient was having a fluid overload, which can also be attributed as an underlying cause for patient having cardiac arrest. The patient in the case study is also observed to be having no particular changes in his reduced air entry in chest. The patient is still being managed with only oxygen therapy apart from any other intervention. The patient undergoes a chest X-rays in quite later stages of the treatment plan. The patient in the case study is also mentioned to be in a positive fluid balance. This is a direct sign of the patient being in fluid overload which is a main reason for mortality and morbidity in the patient (Lex, 2016). The patient having sepsis are more liable to have a high mortality rate due to this. The main focus was given in sodium levels and the urine output, but the underlying cause of positive fluid balance was overlooked completely. Positive fluid balance in the body is bound to put additional stress on every bodily functions including renal, cardiovascular, endocrine, and respiratory as well as central nervous system as well (Cree, 2018).

The nurse was also unable to recognize for the implications of not properly monitoring the saturation rate in the patient. The patient is having an active respiratory infection and was in a dire need of oxygen therapy for managing the ventilation. The decision for discontinuing oxygenation was not discussed by the nurse prior to taking off the oxygen support from the patient. A good clinical judgment was not made to note for the sufficient fluctuation in the saturation rate post removal of the supplement oxygen. The main ethical complication in the case study is not informing the senior authorities aligned in the care of the patient. The nurse also failed to maintain a proper communication channel between each other, before moving on with any change in the treatment of the patient. There was also a delay in effective communication in between physicians involved in the patient care as well as between the nurses and the physicians (Valizadeh, 2017).

The doctors were not methodical to note for the underlying factors and they also failed to note for the deteriorating patient’s condition, lying in plain sight. They also overlooked on the comments made by the nurses, who noted for the signs of decreased urine output in the patient. Those remarks were absolutely overlooked by the doctors and no timely action was taken on the same. The parents were also not well informed regarding the updates on the patient’s clinical signs and symptoms and were also not kept in close loop during conversations regarding further management and care of the patient. The due consent of the parents and seniors were not taken in the case study before discontinuing the oxygen therapy and giving a bath to the patient. Being a 3-year-old he was also not monitored during the bath and was unsupervised throughout the process. This is a major ethical implication in the case study which can be reflected as loop-hole in maintaining patient safety throughout the care delivery to the patient. Patient was in the hands of the safety of the nurses and a lack of supervision and neglect can be reflected in the given case scenario, on the part of nurses.

Recommendations on Managing Complex Clients

The main recommendation in the case study was the inability of the clinical team to recognize and respond to acute deteriorating of the patient. The clinical team aligned in the patient care was unable to recognize for the obvious signs of deterioration reflected by the patient. The NSHQS standard of recognition includes recognizing and taking action promptly in response to the clinical signs and symptoms. This has to be dully noted in terms of both physical as well as mental status (Ghazaly, 2018). This should also include escalating the care of the patient post-recognition of the same. Some of these signs included noting for reduced air entry in lung spaces, tagged along with an underlying respiratory tract infection. Knowing so the team did not conduct a specific diagnostic exam for the underlying causative organism that must be liable to cause the chest infection in the patient. The patient also had a reduced air entry in the lung passages, still he was managed conservatively only. The patient had puffy eyes and was having an obvious edema as well. The patient was also in a positive fluid balance which was neglected at all times.

Noting for the clinical signs and symptoms is very crucial as a part of nursing care. Early and timely identification of these symptoms are shown have bring about improved outcomes in the patients and are also helpful in stabilizing their deteriorating condition. For inferences the care of such patients can be managed by inculcation of implementing standardized protocols and procedures in identifying for the signs and responding to acute deterioration. The effectiveness of reporting such incidences can also be highlighted in order to promote smooth facilitation of the care process and reduce the chances of faulty treatment management in acute care settings. Another major issues that surfaced up from the case study included lack of clinical governance and good defined leadership roles and responsibilities. Good clinical governance is mainly required to maintain the safety and quality of the system. This also helps in maintaining improved reliability, safety and quality of the healthcare with improved healthcare outcomes in the patient (Corfield, 2018). Although the physicians and the nurses aligned in the care of the patient were well-qualified, but they were unable to put their skills to good use.

They failed to identify for the adverse signs and symptoms. They were also reflected as incompetent to work along as a team approach to manage the care for the patient. The safety of the patient was also pre-disposed to a high risk during the management. The patient being a young one, was left unsupervised while he was having a bath all on his own. The governing and managing body are an integral component who are held accountable for ensuring the safety of the patient. Clinical governance can be maintained by setting the goals and priorities of the patient care. Monitoring and reporting of the action analysis should also be done to assure that safe clinical practices are followed throughout the patient care and coordination. The leadership should also work along with the team to manage the care of the patient. Leadership should also be able to develop a safe clinical framework to ensure that the patient safety is maintained as the top most priority. The case study also lacked good communication skills between the team members (Sagherian, 2017). Communication is important to ensure that the information is transferred from one person to another.

Communication should not only be maintained between the interdisciplinary team, but between the care managers and the family members of the patients as well. There was a big communication gap between the physician and the nurses when even after being pointed out by the nurse, the doctor neglected in the fact that the patient was not having a good urine output. The puffiness near the eyes went on to go unnoticed by the team. The communication was also ineffective between the two nurses managing the care of the patient (Dunstan, 2020). They lacked in basic professional adequacy in sound clinical judgment. The communication between the subordinate and the higher authority also lacked in the process. Nurses should be imparted education on legal and ethical implications such situation can bring about, that lacks effective communication between the two parties. The leadership should also have a good governance skills and should be able to provide direction to the team, especially in cases where acute care is to be given to the patient. The communication between the healthcare professionals and the families of the patients should also be maintained in order to avoid any legal as well as ethical implication.

Dully signed consent form from the patient or from the family members, in cases where patient might be a minor or not in a physical sate to do so, should be taken, before commencing with any intervention. Due documentation of the same is also a mandate procedure that should be followed to keep a written track of the turn of events (Wilson, 2019). The adverse signs and symptoms were not analyzed in terms of comprehensive assessment. The nurses and the clinical team also failed to connect the dots together that were reflected by the patient, in the form of adverse signs and symptoms. Comprehensive assessment is a relevant and crucial part of the nursing care and it should be done diligently before commencing with any intervention or care plan for the patient. The delay in noting the signs and symptoms and conducting the required diagnostics tests can lead the patient into further deterioration of the signs and symptoms. It also ends in losing the crucial time in managing the care for the patient in an acute care setting. Timely intervention and recognition is needed to tackle with the same. Thus, ensuring patient safety and reducing the fatality rate by multiple folds.

Conclusion on Managing Complex Clients

Acute care settings demand for an early detection and intervention in the patient care. It should be comprised of sound clinical judgment and effective communication between the team members. The evaluation and constant documentation should be done in order to keep a close track on the patient’s progress and check for any deflection in the signs and symptoms, shifting towards being deteriorating. The patient should also be managed while keeping a close consideration on the legal and ethical implications related to the care management. The safety of the patient should also be kept as the top most priority in the care management of the patient and the situation should be dealt with by keeping a close consideration for the same.

References for Managing Complex Clients

Chua, W. L., Legido-Quigley, H., Ng, P. Y., McKenna, L., Hassan, N. B., & Liaw, S. Y. (2019). Seeing the whole picture in enrolled and registered nurses’ experiences in recognizing clinical deterioration in general ward patients: A qualitative study. International Journal of Nursing Studies, 95, 56-64.

Corfield, A. R., Silcock, D., Clerihew, L., Kelly, P., Stewart, E., Staines, H., & Rooney, K. D. (2018). Paediatric early warning scores are predictors of adverse outcome in the pre-hospital setting: A national cohort study. Resuscitation, 133, 153-159.

Cree, M. L., Stocker, C. F., Tu, Q. M., & Scaini, L. F. (2018). Adherence to standard medication infusion concentrations and its impact on paediatric intensive care patient outcomes. Australian Critical Care, 31(4), 213-217.

Dunstan, E., & Coyer, F. (2020). Safety culture in two metropolitan Australian tertiary hospital intensive care units: A cross-sectional survey. Australian Critical Care, 33(1), 4-11.

Ghazaly, M., & Nadel, S. (2018). Characteristics of children admitted to intensive care with acute bronchiolitis. European Journal of Pediatrics, 177(6), 913-920.

Ibrahim, J. E., Kipsaina, C., Martin, C., Ranson, D. L., & Bugeja, L. (2019). Variations in death notification of nursing home residents to Australian Coroners. Injury Prevention, 25(5), 357-363.

Lex, D. J., Tóth, R., Czobor, N. R., Alexander, S. I., Breuer, T., Sápi, E., ... & Székely, A. (2016). Fluid overload is associated with higher mortality and morbidity in pediatric patients undergoing cardiac surgery. Pediatric Critical Care Medicine, 17(4), 307-314.

Malbrain, M. L., Van Regenmortel, N., Saugel, B., De Tavernier, B., Van Gaal, P. J., Joannes-Boyau, O., .& Monnet, X. (2018). Principles of fluid management and stewardship in septic

shock: it is time to consider the four D’s and the four phases of fluid therapy. Annals of Intensive Care, 8(1), 66.

Massey, D., Chaboyer, W., & Anderson, V. (2017). What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature. Nursing Open, 4(1), 6-23.

Murphy, H. J., & Selewski, D. T. (2019). Mounting Evidence, Improving Understanding: Continuous Renal Replacement Therapy in Critically Ill Children. Pediatric Critical Care Medicine, 20(4), 379-380. doi: 10.1097/PCC.0000000000001822

Pardue Jones, B., Fleming, G. M., Otillio, J. K., Asokan, I., & Arnold, D. H. (2016). Pediatric acute asthma exacerbations: Evaluation and management from emergency department to intensive care unit. Journal of Asthma, 53(6), 607-617.

Sagherian, K., Unick, G. J., Zhu, S., Derickson, D., Hinds, P. S., & Geiger‐Brown, J. (2017). Acute fatigue predicts sickness absence in the workplace: A 1‐year retrospective cohort study in paediatric nurses. Journal of Advanced Nursing, 73(12), 2933-2941.

Treacy, M., & Caroline Stayt, L. (2019). To identify the factors that influence the recognizing and responding to adult patient deterioration in acute hospitals. Journal of Advanced Nursing, 75(12), 3272-3285.

Valizadeh, L., Zamanzadeh, V., Ghahramanian, A., Aghajari, P., & Foronda, C. (2017). Factors influencing nurse-to-parent communication in culturally sensitive pediatric care: a qualitative study. Contemporary Nurse, 53(4), 474-488.

Wilson, E., & Taylor, N. F. (2019). Clinical Supervision for Allied Health Professionals Working in Community Health Care Settings: Barriers to Participation. Journal of Allied Health, 48(4), 270-279.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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