A To E Assessment

For Mrs Jones’ case, the immediate management to slow the progress of deterioration would include initiating treatment measures to increase oxygen levels and consciousness and review of regular assessments (Culter, 2002). If further deterioration persists into abnormal observations reflecting the rapid response criteria, then escalation to notify the nurse in charge and the medical emergency teams (MET) would be required (Knox Private Hospital, 2013) as per noted in escalation protocols and policies. Escalation to review may also arise when the clinician’s intuitive sense purely identifies the patient as at risk of deterioration (Lyneham et al., 2008). The MET calls are Australia’s earliest initial initiative to prevent severe deterioration, which involves the deployment of Medical Fellow and Intensive Care Unit staff to review patients at risk (Swartz, 2013; Chan et al., 2010). Timely and effective intervention of medical emergency response was conducted in a trial study conducted where 23 randomised Australian hospitals were introduced to MET (Hillman et al., 2005). MET calls were significantly increased which improved mortality as

Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).

Through basic observations, health professionals are able to evaluate the performance of an individual’s health status. In relation to Casey, it is noted in her Observation Chart that in the time span of two hours the patient’s health status had changed from being relatively normal (to the patient) to an increased respiratory rate, heart rate and temperature as well as a decrease in blood pressure. It is also noted that the patient has a score of 8 in the pain scale (compared to the score of zero two hours previously), relating to the lower abdomen. Programs such as Between the Flags acknowledges the fact that the early recognition of deterioration of patients can reduce harm to patients through designing and implementing systems which provide a structural response in the event of a deteriorating patient, such as Rapid Response and Clinical Review. There are two phases involved in the rapid response, which includes the afferent phase and the efferent phase. The afferent phase focuses on the overall monitoring and recognising the deteriorating patient whereas

Assessment is a valuable tool to measure students learning and achievement. It is an essential element for teacher to reflect on what and how they teach. To assess students is to collect evidence of their learning. Teachers use the information to modify their lesson plans and adjust their instructional methods; students need feedback on their performance to concentrate on their vulnerable areas. Assessment is necessary for parents to reinforce their children strength and assist them where extra attention is required. The data collected will inform school

In the first step of the Tanner (2006) model nurses use their personal knowledge and experience to notice whether the patient requires attentions based on their expectations and looking at environment of the patient. Therefore, for an experience nurse it is easier for them responding to the similar situation if she or he revisit because the knowledge is already there through experience. In the case of Mr Devi, assessment will perform using systematic assessment based on the ABCDE approach (Airway, Breathing, circulation, Disability and Exposure). The ABCDE approach is an evidence-based practice widely accepted and used by all the members of a multidisciplinary team (MDT) to assess an acutely ill patient (Harrison and Daly 2011). First, life-threatening

Assessment of a patient is a big process of decision making, it is about the collection of information which will contribute to an overall judgement of a person and the illness they may have. Lloyd (2010) states that assessment is one of the first steps which is needed to be done in the nursing process, it is a building block for a relationship and an ongoing process which lets health professionals gather the correct information to help them understand the problems and needs that the patient is going through. Most of the nursing assessment which are in use today will all have very similar aims. The difference is that how the assessment’s are carried out is where the differences come from.

The reliability of an assessment in a perfect situation should produce the same results if marked by another tutor or if that examiner unknowingly receives the same paper again. If different marks are given the assessment is consequently unreliable and proves that this assessment is subjective.

Neurological Assessment: patient is awake and alert times 4. Denies head injury, seizures or seizure disorder, paralysis, or abnormalities of sensation and gait coordination. Denies syncope dizziness, vertigo, memory loss, speech coordination, frequent headaches, or tremors. Denies problems with speaking.

In neropsychology, there are many assessments and tests such as the Glascow Coma Scale, the NAART, the Weschler WTAR, all of these and more can be used to assess Mary’s premorbid abilities and compare them to after her accident. In the Glascow Coma Scale, one of the assessed on the following functions, eye opening, verbal response, and motor response (Tsdale, Jennett. 1974). Eye opening can be spontaneous, to the sound of a voice, and response to pain, or not at all (Tsdale, Jennett. 1974). Verbal response can be normal conversation, disorientated conversation, words, but not coherent, no words, only sounds, or none at all (Tsdale, Jennett. 1974). Motor response can be normal, localized to pain, withdrawal to pain, abnormal posture, or none (Tsdale, Jennett. 1974).

7.7. During clinical placements I have used various assessment tools, such as the Glasgow Coma Scale (GCS), when caring for patients with long term conditions. The GCS gives a reliable, objective way of recording the conscious state of a person (Teasdale & Jennett, 1974). It is used by both medical and nursing staff for initial and continuing assessment, and has a value in predicting an ultimate outcome for the patient. Within each category (eye-opening, verbal and motor responses), each level of response is allocated a numerical value, on a scale of decreasing neurological deterioration. Three figures are obtained in each section, which add up to a maximum score of 15 and a minimum of three.

GCS is a standardised assessment tool that has significant implications such as providing a baseline, detecting early signs of deterioration and evaluation of severity of the brain injury (Middleton, 2012). The three domains of GCS are eye opening, verbal and motor response. The eye opening reflects arousal levels originating from brainstem activity. The verbal component requires the use of cerebral cortex and reveals the patient’s awareness and orientation

Disability – Assessment of disability involves evaluating the patient’s central nervous system function. Assess the patient’s level of consciousness using the AVPU scale. Talk to the patient if they are alert and talking they are classified as A. If the patient is not fully awake establish whether they respond to the sound of your voice (opening their eyes, making any sounds) if they do they are classified as V. If the patient does not respond to voice administer a painful stimulus (gently rubbing the sternum bone). If they respond they are a P on the AVPU scale. And finally if they do not respond to any of the above they are a U, you should then move onto the more detailed Glasgow Coma Scale (GCS). You will assess the patient’s pupils (eyes) and motor responses (arms and legs) among other things to give the patient a score out of 15 (15 being the highest). A GCS of fewer than 8 is a medical emergency and you would then have to go back to assessing the patient’s airway.

Some clinicians feel that scoring eye opening is not sufficient to indicate brainstem arousal and a number of coma scales have been proposed that include brainstem reflexes, most of them more complex than the GCS scale (Majerus, 2005). The Glasgow Liège scale is the simplest variation proposed (Born, et al., 1982). It combines the GCS with five brainstem reflexes, but has not been widely implemented outside Belgium, its country of origin (Laureys, 2005).

At the initial visit, the investigator collected patients’ demographic data from patient’s records by using the Semi Structured Demographic questionnaire. Then the investigator assessed conscious level by using Glasgow coma scale (GCS) for every participant and APAHCII scale to detect the severity of the TBI within the first 48hours of ICU admission. Each participant was examined in both positions (30° & 45°). The choice of 30 degree elevation for this study was based on the traditional recommendations prescribed for the head injured patients as well as anatomical and scientific data. Participants served as their own controls. All participants had a 15 minute rest before the positioning so that any previous nursing activities will not affect

The Human Resource Map (HRPM) was developed by the CIPD it was created by generalists and specialists within the CIPD/HR environments to explain how HR add value to any organisation within the UK and around the world. The (HRMP) is a guideline/benchmarked on line tool which can help individuals and organisations identify immediate and future development needs. The purpose of this (HRPM) is to capture the key skills required for the successful and effective Human Resource Function. The HRPM gives direction and shows what needs to be done, what the individual needs to know and