Task Solutions Of Governance and Regulatory Environment:EV1010

Preview text

Running head: Epidemiology
Epidemiology
Name of the student:
Name of the University:
Author â€snote
1 EPIDEMIOLOGY
Abnormal assessment data and pathophysiology
In the video, anurse was found to complete adetailed assessment of the patient, who
underwent an open heart surgery eight weeks ago. The nurse completes series of assessment
for the patient such as subjective assessment of problem and objective assessment by
focusing on blood pressure, pulse, auscultation of the heart, assessment of the skin colour and
edema. One abnormal assessment data found in the video was high blood pressure value of
143/84. It is abnormal and the patient also confessed that his BP was not so high before.
The underlying health problem for the patient is cardiovascular disease. He had to
undergo heart surgery and an aortic valve was replaced. Thus, he mainly had adisease that
affected his aortic valve. The aortic valves play acrucial in the opening of the blood vessels
and allowing the flow of the blood from the left ventricle into the aorta. However, when the
aortic valve does not work properly, it interferes with the blood flow and increase the
workload of the heart (Im Cho et al., 2018). According to Zeng et al. (2016), valvular heart
disease is amajor health problem seen in elderly patients and it is associated with various
problems. Two types of mature valves seen in the heart are atrioventricular valves and the
semilunar valves. These valves consist of an outer layer of endothelial cells along with three
layers of extracellular matrix. The three layers are made up of collagens, elastins and
proteoglycans and it offers biomechanical support to the valves. Various genetic and/or
environmental factors affect the composition of the extracellular matrix and alter the valve
mechanics. This interferes with the valve leaflet functioning and contribute to heart failure.
Inflammation can contribute to many macro-vascular complications.
The patient was found to be at risk of high blood pressure. People who have long-term
hypertension have an increased risk of aortic valve disease. Aortic valve disease (AVD)
increases the risk of high blood pressure. This occurs because AVD contribute to the
2 EPIDEMIOLOGY
narrowing of the blood vessels and increase the pressure within the heart. It decreases the
ability of the heart to pump and thus people with such problems have a high risk of
hypertension (Rahimi et al., 2018).
Potential acute deterioration
The patient was found to have ablood pressure of 143/84. This data is asign of risk
of clinical deterioration and if the above symptom cannot be identified in atimely manner,
the patient may be at risk of chronic heart failure too. It can increase the chances of mortality
for patients. According to Yeoh and MacCarthy (2019), hypertension is one of the significant
risk factors for cardiovascular disease and itis the leading cause of mortality. Around 54% of
people with strokes and 47% of people with coronary heart disease are because of the risk of
hypertension. Patients who experience high blood pressure after aortic valve replacement
needs to intensify antihypertensive treatment. They are at high risk of complications and
intensification of antihypertensive treatment can increase prognosis by increasing stroke
volume and cardiac output. The patient was an open heart surgery patient and the evidence by
Balzer et al. (2016) revealed that changes in intraoperative blood pressure can increase the
short and long-term adverse consequences for patients. It is associated with an increase in
hospital stay, higher mortality rate and high incidence of renal dysfunction.
3. Critique of RN â€shealth assessment and communication skills:
One of the major responsibilities of registered nurse (RN) is to conduct
comprehensive and systematic assessment of patients. The importance of comprehensive
health assessment is that it can help to evaluate current health status of patients and evaluate
physical, mental and socioeconomic conditions. In the video, the nurse was found to
systematically complete all the assessment process. She started with introducing herself and
then started with completing the subjective assessment process. It involves using certain
3 EPIDEMIOLOGY
questions to assess patient â€slevel of alertness and frequency of palpitations. For instance, the
patient described that he suffered palpitations last night. In response to the issue described,
the questions posed by the nurse were appropriate. She asked about ‘how many times did that
happen? â€and ‘how long did that last? â€.The advantage of using such skills is that it can
increase the severity and nature of the patient â€scondition (Wideman et al., 2019). This is
indicative of that fact that the RN has knowledge about the ways to systematically collect
data. This is relevant to the standard 4.2 which states that the RNs should use range of
assessment techniques to systematically collect data and inform practice (NMBA, 2017).
Secondly, after completing the subjective assessment related to the current symptoms,
the nurse aimed to complete patient history taking process. It involved starting with collecting
data on past health history of patient. The patient revealed that he had aheart surgery eight
weeks ago. However, the weakness in the assessment process was that the nurses collected
most details on the heart surgery but did not inquire about the presence of any other disease
conditions such as diabetes and hypertension. Another gap found in the assessment process is
that itwas not done in aholistically and culturally relevant manner. For instance, the RN was
very particular about the list of assessments to be completed such as BP, pulse and edema
assessment. But throughout the assessment process, the use of holistic approach was missing.
The focus was just on collection of physical health data instead of psychosocial data.
According to Mills (2017), use of holistic approach can ensure the development of high
quality care. It involves taking into account physical, psychological and social well-being of
people. The success of holistic assessment depends on the ability to connect with patients and
trying to identify more than just physical symptoms. Holistic care is based on the idea of
holism and itinvolves listening to patient â€sthoughts, emotions and attitude while focusing on
recovery. However, throughout the conversation, RN â€s did not focused on psychosocial
aspects of care (Zamanzadeh et al., 2015). This is in violation of the NMBA standard 4.1
4 EPIDEMIOLOGY
which states that the nurse should conduct assessments that are holistic and culturally
relevant. The RN â€saction was in violation of these standards.
Apart from clinical knowledge, the effectiveness of the nursing assessment process
depends on the use of appropriate communication skills too. According to the NMBA
standard 2.2, the nurses should communicate effectively and they should be respectful of the
dignity, culture, values and beliefs of the patient
(NMBA, 2017). The purpose of effective communication skill is to integrate implementation
of nursing care and it involves taking the approach to develop mutual respect for the patient.
Effective communication is associated with patient â€ssatisfaction with care and increase in the
quality of nursing care too. The strength of the RN â€scommunication skill is that she briefly
informed the patient about the each assessment and how she would complete it (Lotfi et al.,
2019). She was found to be friendly, attentive and approachable. She was smiling in between
and informing the patient about the likely consequences of each assessment. The advantage
of such approach is that it helps in developing therapeutic relationship with patients and it
eliminates any form of confusion or uncertainty from the perspective of patients.
The use of patient-centered approach in communication was missing by the RN in
some aspects. For example, the standard 2.2 posits that the nurse should be respectful of
person â€sdignity, culture and beliefs (NMBA, 2017). However, the RN was found to miss the
elements of PCC to some extent. For instance, before completing the chest auscultation
process, the RN was found to open the shirt of patient. She asked him to undo his shirt
buttons. However, she did not check for the patient â€saffirmation. She should first check if the
patient is comfortable with opening his shirts or not. The RN was in arush and she was not
patient enough to look at patient â€snod. However, the patient was found to be comfortable as
he was used to the process. Adib-Hajbaghery and Aghajani (2015) argues that there is aneed
to not only observe the patient dignity but also focus on the mutual rights of patients. Their
5 EPIDEMIOLOGY
privacy and dignity should be observed by the nurses to maintain effective relationship with
them. Failure to comply with patient dignity may lead to stress, anxiety and increase in the
likelihood of aggressive and unacceptable behaviour by patients.
The elements of PCC involve building connection with patients, displaying caring
attitude and promoting control and empowerment of patients. Developing connection
involves engaging in rapport building process and it can help to promote building trusting
relationship. The first two or three minutes of conversation at the beginning is regarded as a
golden period that not only builds the therapeutic relationship but also ensures that future
relationship is enhanced. The RN was smiling in between and keeping the patient in alight
mood. However, aspects of empathy and empowerment contribute to high risk (Mills, 2017).
6 EPIDEMIOLOGY
References:
Adib-Hajbaghery, M., & Aghajani, M. (2015). Patients dignity in nursing. Nurs Midwifery
Stud ,4(1), e22809.
Balzer, F., Aronson, S., Campagna, J. A., Ding, L., Treskatsch, S., Spies, C., & Sander, M.
(2016). High postoperative blood pressure after cardiac surgery is associated with
acute kidney injury and death. Journal of cardiothoracic and vascular
anesthesia ,30 (6), 1562-1570.
Im Cho, K., Sakuma, I., Sohn, I. S., Jo, S. H., & Koh, K. K. (2018). Inflammatory and
metabolic mechanisms underlying the calcific aortic valve
disease. Atherosclerosis ,277 ,60-65.
Lotfi, M., Zamanzadeh, V., Valizadeh, L., & Khajehgoodari, M. (2019). Assessment of
nurse –patient communication and patient satisfaction from nursing care. Nursing
open ,6(3), 1189-1196.
Mills, I. J. (2017). A person-centred approach to holistic assessment. Primary dental
journal ,6(3), 18-23.
Nursing and Midwifery Board of Australia (2017 ). Registered nurse standards for practice.
Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-
statements/professional-standards/registered-nurse-standards-for-practice.aspx
Rahimi, K., Mohseni, H., Kiran, A., Tran, J., Nazarzadeh, M., Rahimian, F., … & Otto, C. M.
(2018). Elevated blood pressure and risk of aortic valve disease: acohort analysis of
5.4 million UK adults. European heart journal ,39 (39), 3596-3603.
Wideman, T. H., Edwards, R. R., Walton, D. M., Martel, M. O., Hudon, A., & Seminowicz,
D. A. (2019). The multimodal assessment model of pain: a novel framework for
7 EPIDEMIOLOGY
further integrating the subjective pain experience within research and practice. The
Clinical journal of pain ,35 (3), 212.
Yeoh, J., & MacCarthy, P. (2019). The Pressure Is On: Implications of Blood Pressure After
Aortic Valve Replacement. Journal of the American Heart Association , 8(21),
e014631.
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective
factors in providing holistic care: a qualitative study. Indian journal of palliative
care ,21 (2), 214.
Zeng, Y. I., Sun, R., Li, X., Liu, M., Chen, S., & Zhang, P. (2016). Pathophysiology of
valvular heart disease. Experimental and therapeutic medicine ,11 (4), 1184-1188.