Experiences of health and illness

1. Evaluate the clinical indicators of acutely deteriorating health 2. Critically discuss the nursing care of an acutely ill person 3. Examine the experiences of an acutely ill person and their family taking into consideration their psychosocial needs 4. Deploy clinical tools competently to recognise and respond appropriately to service users at risk of deterioration Scenario: The Patient with Diabetes: Jessica Bowen Jessica Bowen, a 68 year old lady, has been admitted to the medical unit from home. Jessica was found on the floor at home by her husband. She is now on the medical admissions unit. Jessica has type 1 diabetes for which she normally takes Humulin M2®, insulin 2 times daily. Jessica’s husband says that she has not been feeling well and has not been eating or drinking very much. Her current assessment reveals: Airway/Breathing Awake/conscious Resp Rate 18 bpm SpO2 96% Circulation Heart rate 90bpm Blood Pressure 160/90mm/Hg Temp 380 C orally Cap refill 5 secs Urine output < 200mls in previous 12 hours (weight 50kg) Disability AVPU = A Some pain in leg Blood glucose 26mmol/l Exposure Urine dark and malodorous, Dipstick reveals presence of blood, protein, glucose and ketones. Presence of a hot, painful, red track on her right calf Poor fluid intake, very reluctant to drink or eat. Recent weight loss No IV access Possible problems for discussion for Paul • Hypovolaemia – circulatory assessment and management • Management of severe, acute pain • Emergency wound care/infection prevention in trauma • Safe transfer of the acutely ill patient