Student’s Name:

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 1: Possible Causes of Joanna’s changing condition

With the issues of condition change in patient rising, many studies have been undertaking

to ascertain the main causes of the changes (Garratt et al 2001). Patient’s condition can either

change positively or negatively, the studies maybe more challenging to conduct since some

surveys may show improvement in the scores even in the patient who rated themselves as

deteriorating. For symptom based conditions, patient’s outcomes are of paramount importance.

The injuries that Joanne incurred such as the haemopneumothorax, generalised bruising to left

chest and shoulder temporal area, left abdomen, thigh and left arm needs to be monitored carefully

and all its outcomes and changes being recording frequently. As with Joanna her condition is

deteriorating, there are some factors that can be the reasons for these changes. Such reasons may

include, adverse events which may be a management problem, unplanned intensive care unit

admission which is basically related to an admission that could not be deferred without risk for at

least 12 hours, with it leading to poor long term survival most commonly to adults. Joanna’s

condition change may be as a result of errors in management such as the unexpected admission to

the intensive care, in respect to Joanna’s 55 years old suggesting that she was old thus the

unexpected admission may have led to her condition change. This problem can easily be solved if

the management could develop a rapid response team which consists of an afferent limb which is

specifically designed to detect recognize and manage deteriorating patients. And the efferent limb

which has trained personnel forming a rapid intervention teams who can deliver immediate care

and treatment to deteriorating patients. With Joanna having a background and previous medical

conditions such as the hypertension and the recently diagnosed type two diabetics mishandling of

this conditions according to the institutions protocol may as well be the

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cause for Joanna’s condition change as the doctors must consider the early conditions in the

every treatment and action they take, also the human intervention and doctors may also cause the

changes in her conditions, faulty task planning and performance, failure in the patient monitoring

from the nurses may also lead to Joanna’s change. Due to Joanna’s injuries may cause a

progressive deterioration of her normal body parts as the injured left radius and ulna, and also the

limbs are protected. Because of Joanna’s previous medical conditions indicating that she had

some difficulties hence this may also be a reason for her deterioration making her to recover

more slowly painful congestion of blood in her feet and legs which may prevent her from

resuming to a normal state of activities even after being discharged from the hospital. Due to

Joanna’s status and the family relationship she had, being a widower her conditions may have

arisen from the intellectual and emotional factors, with the confusion leading to her loose of

interest in eating and loss of attention to bladder and bowel continence.

1; b: Further deterioration that may occur to Joanna

Joanna conditions are expected to deteriorate further, by the fact that she is not up and active and

as a consequence she does not re-aerate her collapsed alveoli, Lack of re expansion of atelectasis

alveoli produces a progressive congestion in the dependent parts of the lungs (Frederic J, Kottke

2001). Also by the time she will be in bed thus developing the respiratory complications due to

her diminished ventilation. It is also likely that Joanna will develop metabolic imbalances due to

the time she will be bedridden, this is due to the fact that she will be immobile and

immobilization is most likely to cause metabolic imbalances, as the breaking down of proteins

and excretion of nitrogen increases, as a person remains immobile. Due to the injuries she

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Incurred when she fall down the tree thus later the parts that were injured are more likely to be

non-functional. Connective tissues will continuously reorganize itself to provide support for

organs and cells as she continues to lay in bed, the organization will depend on the motion in the

connective tissues, as it is frequently stretched making the shortens to appear to reorganization

rather than formation of new collagen. She may also lose her muscle strength, considering that

muscle power depends on the work which it can do per unit time. The maintenance of a powerful

muscle depends on its exertion of maximal tension at frequent intervals.

2: Comparing and contrasting method of patient assessment between Primary (ABCDE)

and Head to Toe assessment

A patient with a deteriorating condition needs to be frequently assessed; this process can be

made successful by a variety of tools such as the Primary (ABCDE) tool and the head to toe

assessment, the Airway, breathing, circulation, disability, exposure (Smith, D., & et al. (2017).

In providing up to date information about the ABCDE primary approach nurses are supposed to

practice it effectively by applying the four themes of code. This assessment method enables

nurses to identify and provide a quick response to a condition in order of priority. The signs of

the patient should be measured and recorded by a track and trigger tool so as to enhance

recognition of physiological abnormalities that signals deterioration in a patient. The nurses and

the physicians should employ communication tools to optimize communication and escalation of

deteriorating patients. All emergency equipment such as oropharyngeal or nasopharyngeal, a

non-rebreather oxygen mask with reservoir bag, intravenous fluids and appropriate syringes for

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Collecting blood samples should be readily available and that the nurse should clean their hands

with an antiseptic before commencing the assessment (Tvedt and Bukholm 2005). The procedure

for carrying out ABCDE assessment includes, looking, listening and feeling in Airway,

Breathing and circulation with both of them having different approaches in the case of disability

the patients level of consciousness using the Alert, responds to voice, responds to pain and

unresponsive (Council Uk 2015). As in the case of exposure the nurse will perform a head a toe

assessment, where he or she looks, listen and feel any physiological abnormalities which might

indicates the cause of patients cute in registration and associated lack of practical abilities thus

the need for the nurses to acquire the necessary knowledge acute care skills. Head to toe

assessment is used to detect axial and peripheral enteritis to patients with psoriatic arthritis an

axial spondyloarthrisis in which the presence of heel enteritis often is a clinical feature

(Poggenborg, R. P.,et al 2005). The head and toe assessment can detect the inflammatory lesions,

and its distributions. Head to toes assessment has the ability to detect and assess overall disease

activities and structural damages in different body parts, some parts in the bodies such as knees,

hips, Si joints and the spine can easily be visualized by the head to toe assessment, there are also

some areas that are not easily visualized by the head to toe assessment this includes, elbows and

distal joints of the hands and feet, this may be as a result of smaller sizes of the joint causing

spatial resolutions, movement artifacts and the longer distances from the center of magnetic

reasoning imaging (MRI) unit decreasing field homogeneity. More techniques on image

acquisition has been developed for the future hence the head to toe assessment can be conducted

easily in the coming days, more optimal positioning of the patient in the scanner may also

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Facilitate reliable assessment of peripheral joints, it is more difficult to assess very small joints

by the head to toes assessment and therefore the might be falsely negative. The correlation

between the head to toes assessment and the clinical examination (Primary ABCDE), the Bruch’s

membrane opening scores relates significantly with the swollen joint counts in patients with

psoriatic arthritis. Also no association is there between synovitis and clinical joints count. In

contrasting the primary (ABCDE) assessment method and the head to toe assessment it is

concluded by the fact that ABCDE method concerns mostly with theoretical analyzation and

observations of the patients changes this is made possible by looking, feeling and listening, by

the fact that it can be undertook anywhere even in the streets without any equipment makes it

more advantageous than the head to toe assessment it can easily be used to patients with

disabilities. Head to toe assessment concerns with the practical assessment as the nurse needs to

practically examine the patient; his method is commonly used in the structural damages and

assessment of patients with joint problems. All the two methods of assessment requires a trained

nurse in the field so as he or she can record the systematic deteriorating of the patient, head to toe

assessments also require more surgical equipments that can be used to examine certain non-

physical joints. Kouwenhoven and his colleagues discovered ABCDE primary assessment so that

it can help in safe-guarding the airway and delivery rescue breaths considering that unlike Head

to toe assessment primary ABCDE is conducted immediately to respond to the condition and

thus providing instant medical treatments. In emphasizing the critical injuries of the patients

nurses tends to use ABCDE as in the case of (Styner et al 2007) where observed and inadequate

emergency care was provided after they had a plane crush, ABCDE is recommended for all

patients who has a cardiac arrest to patients experiencing all medical and surgical emergencies,

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making it to be a strong tool for the initial assessment of patients in acute settings and also to

provide treatment to them. It mostly helps in determining the seriousness of a condition and

therefore recommending for an initial surgical and clinical interventions, if widely use it also

enhances unity among the health practioners

3; a: Why a change in respiratory rate is an important indicator of clinical

deterioration

An increase or decrease in respiratory rates is a vital assets in clinical deterioration, with

conditions such as tachypnea the increase in the respiratory rates, has been the most important

signal in interventions and treatment of cardiopulmonary arrest, the respirator rates are now

included in the early warning scores because of its importance’s. The main aim of early warning

scores is to combine observations of vital signs to a cumulative result that can possibly identify

physiological deterioration in ill patients at the hospital. Though respiratory rates cannot be used

in patients with respiratory conditions as there are automated techniques which measures

respiratory rate, with an aid of equipments which might interfere the natural breathing process

directly. Conditions such as Respiratory sinus arrhythmia is associated with respiration, thus

respiration plays and important role in modulating the heart rates such that it can increase during

inspiration and decrease during respiration. R. peak modulation the during the process of

respiration the chest due to the filling and empting of the lings causing a rotation in the electrical

axis of the heart that causes modulation of the amplitude of the epidermal growth factor

(Orphanidou, C.et al. (2013) . A predetermined calling criterion to addressing ABCDE which

includes ascertaining respiratory assists nurses and other clinical officers in recognizing

deteriorating patients.

3; b: How Respiratory rate can be measured reliably and accurately

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Some inventions have come up to provide systems that can measure respiratory rates accurately,

this system includes an impedance pneumography sensors connected to two electrodes and a

processing system that receives and process signals from the electrodes to measure the patients

respiratory rates. During and after a surgery respiratory rates of a patient are frequently

monitored. It can be indicate as a patient’s number of breaths within a certain period of time. An

optical sensor can also be used to measure a patient’s respiratory rate the sensor comprising of a

light emmitor configured to impinge light on body tissue of a patient. A bio-impedance sensor

and a capnography censor designed to an acoustic respiration signal from a living patient. And a

processor configured to: obtain a first respiratory rate measurement from the physiological

signal, obtain a second respiratory rate measurement from the acoustic respiratory signal, and

calculate a confidence in the first respiratory rate measurement responsive to the first and the

second respiratory measurements.

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 References.

Poggenborg, R. P., Pedersen, S. J., Eshed, I., Sørensen, I. J., Møller, J. M., Madsen, O. R., ... &

Østergaard, M. (2015). Head-to-toe whole-body MRI in psoriatic arthritis, axial

spondyloarthritis and healthy subjects: first steps towards global inflammation and damage

scores of peripheral and axial joints. Rheumatology, 54(6), 1039-1049.

Orphanidou, C., Fleming, S., Shah, S. A., & Tarassenko, L. (2013). Data fusion for estimating

respiratory rate from a single-lead ECG. Biomedical Signal Processing and Control, 8(1),

98-105.

Thim, T., Krarup, N. H. V., Grove, E. L., Rohde, C. V., & Løfgren, B. (2012). Initial assessment

and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE)

approach. International journal of general medicine, 5, 117. Chicago

Smith, D., & Bowden, T. (2017). Using the ABCDE approach to assess the deteriorating

patient. Nursing Standard (2014+), 32(14), 51.

Coyne, K. S., Matza, L. S., Kopp, Z., & Abrams, P. (2006). The validation of the patient perception

of bladder condition (PPBC): a single-item global measure for patients with overactive

bladder. European urology, 49(6), 1079-1086.

Barker, M., Rushton, M., & Smith, J. (2015). How to assess deteriorating patients. Nursing

standard, 30(11), 34-36