Nursing Prioritization of Health Issues
Nursing Prioritization of Health Issues
Identification of nursing focused priority health issues
One of the nursing focused priority issues is breathlessness, also referred to as dyspnea. Dyspnea is considered a subjective experience of discomfort in breathing that entails of qualitatively different sensations that differ in intensity (Carpenito, 2009). The bases of dyspnea are several, encompassing psychological, environmental, physiologic, and social etiologies that might result in secondary behavioral and physiologic responses (Oriolo & Albarran, 2010). Monitoring of the respiratory pattern tackles the patient’s ventilatory depth, rate, and pattern. Several acute pulmonary deteriorations are preceded by breathing pattern’s change. Respiratory failure are seen with a change in normal thoracic and abdominal patterns for expiration and inspiration, change in ventilation or depth, respiratory alternans, as well as change in the rate of respiration (Ignatavicus & Workman, 2010). Changes in breathing pattern may happen in a large number of cases from heart failure, airway obstruction, pain, hypoxia, anxiety, drug overdose, and infection (Ignatavicus & Workman, 2010). This is why breathlessness is considered the first nursing health issue in reference to the case study.
Anxiety is the second priority health issue. Anxiety is referred to as an unclear troubled feeling of dread or discomfort coupled with an autonomic response (Jensen, 2011). It is also a feeling of nervousness brought about by anticipation of danger. Anxiety is almost certainly present at some stage in every person’s life, although the frequency and the degree with which it presents differ broadly. Every individual’s reaction to anxiety is different. A couple of people can use the emotional edge, which anxiety incites to stimulate creativity; others can turn out to be immobilized to a pathological level (Carpenito, 2009). The nurse’s presence might provide support to the patient that is anxious and offer some strategies for pass through anxious moments (Jensen, 2011).
Adverse drug reaction (ADR) is the third priority health issue. According to the World Health Organization (WHO) ADR is any drug response, which is unintended and noxious, and which takes place at doses usually used in a person (Ignatavicus & Workman, 2010). Taking numerous drugs for multiple conditions of health raises ADRs’ risk, particularly in older patients. Even though polypharmacy can be suitable in cases of numerous comorbidities, prescribers ought to take into consideration physiologic changes in the organ function of the older adult because of disease and aging. Improved administration of medication may possibly prevent nearly 2.5 million adverse drug events (Ignatavicus & Workman, 2010).
Prioritization of nursing focused health issues supported with literature
Respiratory assessment where dyspnea is easily identified is considered as an essential part of health assessment and is very helpful in patient management. Ignatavicus & Workman (2010), state that the respiration rate particularly, has been identified particularly as a sensitive indicator of clinical deterioration in patients who are critically ill. In understanding the significance of the rate of respiration, it is argued that any rate of respiration above 20 respirations per minute is a considerable indicator for identification of severe sepsis (Higginson & Jones, 2009).This condition can be a potential life threat if not identified early and suitably acted on. The patient’s respiration rate is 28 bpm when the normal rate of respiration in adults ranges from 12 to 18 breathes/minute (Ignatavicus & Workman, 2010).
Parkes (2011) contends that the respiration rate is the first indicator of physiological worsening and requires to be documented with other vital signs. Recording respiratory rate facilitates baseline assessment of ventilator function being created and can offer early respiratory deteriorations’ signs. Assessment of respiration coupled with respiratory management skills constitute part of fundamental critical care skills required by every nurse (Higginson & Jones, 2009). An alert nurse in detecting complications in a timely manner is in good position of reducing negative outcomes in a patient. Through early identification of breathlessness and elevated respiratory rate, which are both indications of a serious underlying medical issue, the patient’s condition is likely to be improved through taking the right interventions.
With regards to anxiety, one of the nursing interventions is to reduce the patient’s level of anxiety through provision of comfort and reassurance; staying with the patient; speaking calmly and slowly to/with the patient; and attending to physical symptoms (Ignatavicus & Workman, 2010). Some of the symptoms related to anxiety may be evidenced by restlessness, sweating, and elevated respiratory rate. Most patients who are anxious may not comply with simple instructions, hence calming the patient is imperative (Jensen, 2011) and this is why it is considered the second priority.
Age comes with the view of numerous health issues that call for treatment with several medications. When taking care of an older adult taking several medications, nurses should remember that concurrent multiple medications’ use raises the potential for ADRs as well as drug interactions (Lawrenson, 2009). Pharmacokinetic change related to age is able to alter drug absorption, metabolism, distribution, and excretion; for instance, a lot of aged patients have renal impairment that affects absorption and excretion of the drug and is able to alter the levels of blood drug (Lawrenson, 2009). In pharmacodynamics, age-related changes can alter the effects of a drug. This is why every healthcare professional needs to report an incidence of ADR.
Medication errors’ prevention is an outline for change in safety of medication through identification of opportunities to improve practices and systems to offer safety of the patient (Ignatavicus & Workman, 2010). As the numbers of medications being administered raises, nurses experience a growing challenge of knowing drug actions, correct dosage, and side effects. One way of reducing adverse drug events is by making sure that allergies of medications are correctly documented and that ADRs are reported promptly (Ignatavicus & Workman, 2010). However, the lack of knowledge by nurses concerning medication is a constant issue and a basis of not reporting ADRs. The unwanted consequences of an ADR may include and not limited to illness, increased cost, prolonged hospitalization, and possible fatality (Ignatavicus & Workman, 2010).
Nurses have the responsibility of surveying, preventing, treating, and documenting ADRs as well as medication allergies. Other activities entail time/dose, unwanted effects, work arounds (like shortcuts, which do not abide by the procedure), and administration of medications. Prompt identification of an ADR coupled with an action is likely to be lifesaving. Kaufman (2011) contends that a lot of avoidable ADRs in hospitals relate to nurses’ knowledge as well as medications’ administration. When nurses give medications, their thinking extends beyond procedures and rules since they put into consideration the condition of the patient and apply their professional knowledge (Roux & Halstead, 2009). The increasing numbers of medications, interactions, as well as medications that sound similar complicate the issue (Ignatavicus & Workman, 2010). Nurses ought to remain alert to patients that are elderly with more chronic diseases and drugs that can raise ADR’s risk.
Nurses have a sole opportunity of observing and detecting ADRs since they are final point of administration of medication (Kaufman, 2011). Their observation that is around-the-clock of hospitalized patients facilitates them to recognize early indicators of an issue. Since errors of medication are powerful risk factors for avoidable ADRs, nurses require strategies of prevention. Such strategies entail making sure that every individual involved in the process of medication (nurses, physicians, and pharmacists) have considerable pharmacological knowledge (Ignatavicus & Workman, 2010).
The role of the nurse related to regulatory frameworks and health department policies
Professional competence is imperative for every nurse since it directly impacts on the patient’s outcome. One of the nurse’s competencies is demonstrating patient safety. Medicines are considered as the most frequent treatment used within health care (ACSQHC, 2011). Since they are so frequently used, medicines are linked to a greater occurrence of adverse events and errors than other healthcare interventions (ACSQHC, 2011). Some of the incidents are expensive and potentially preventable.
Another nursing competency is that a nurse should integrate health care and nursing knowledge, attitudes and skills to offer effective and safe nursing care by maintain a present knowledge base (ANMC, 2006). The nurse should also determine agreed priorities that resolve individuals’ health needs. The nurse should also establish priorities for care, grounded on nursing assessment of an individual’s needs for intervention, research and present nursing knowledge. Nursing competencies also calls for provision of comprehensive, effective and safe nursing care that is evidence-based to achieve identified individual’s outcomes (ANMC, 2006).
Nursing competencies also stipulates that the registered nurses (RN) will effectively manage the individuals’ nursing care by performing actions in a way consistent with related nursing principles (ANMC, 2006). The RN should also respond effectively to rapidly or unexpected changing situations. This will be demonstrated by responding to emergencies effectively; maintaining self-control during the clinical setting as well as under stress situations; implementing interventions of crisis and emergency practices as required; and maintaining present knowledge of emergency procedures and plans to maximize efficiency during crisis situations (ANMC, 2006). Once a nurse has these competency skills, he or she will be able to promote patient outcome even in patient’s deteriorating conditions.
Australian Nursing and Midwifery Council (ANMC). (2006). National competency standards for the registered nurse. Canberra: Australian Nursing andMidwifery Council.
ACSQHC, Sydney. National Safety and Quality Health Service Standards, Australian Commission on Safety and Quality in Health Care (ACSQHC), 2011,
Carpenito, LJ, 2009, Nursing care plans & documentation: Nursing diagnoses and collaborative problems, Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Higginson, R & Jones, B, 2009, Respiratory assessment in critically ill patients: airway and breathing, British Journal of Nursing, 18(8).
Ignatavicus, DD & Workman, ML, 2010, Medical-surgical nursing: patient-centered collaborative care, St. Louis, MO: Saunders Elsevier.
Jensen, S, 2011, Nursing Health Assessment: A Best Practice Approach, Philadelphia: Lippincott Williams & Wilkins.
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Oriolo, V & Albarran, JW, 2010, Assessment of acute chest pain, Br J Cardiac Nurs, 5(12): 587-593.
Parkes, R, 2011, Rate of Respiration: The Forgotten Vital Sign, Emergency Nurse, 19(2).
Roux, GM & Halstead, JA, 2009, Issues and trends in nursing: Essential knowledge for today and tomorrow, Sudbury, Mass: Jones and Bartlett Publishers.