• Choose a category
• All
• Classic-Fiction

a Gastroscopy.

a Cystoscopy.

a Arthroscopy.

8 Which of the following can a patient not have if they have a pacemaker in situ?

a MRI.

a X-ray.

a Barium swallow.

a CT.

9 If a patient feels a cramping sensation in their abdomen after a colonoscopy, it is advisable that they should do/have which of the following?

a Eat and drink as soon as sedation has worn off.

b Drink 500 mL of fluid immediately to flush out any gas retained in the abdomen.

c Have half-hourly blood pressure performed for 12 hours.

d Be nursed flat and kept in bed for 12 hours.

10 A patient in your care is about to go for a liver biopsy. What are the most likely potential complications related to this procedure?

a Inadvertent puncture of the pleura, a blood vessel or bile duct.

b Inadvertent puncture of the heart, oesophagus or spleen.

c Cardiac arrest requiring resuscitation.

d Inadvertent puncture of the kidney and cardiac arrest.

These multiple choice questions are also available for you to complete online. Visit www.royalmarsdenmanual.com and select the Student Edition tab.

Answers to the multiple choice questions can be found in Appendix 3.

Chapter 12

Observations

Overview

The following observations will be discussed: pulse, blood pressure, respiration, peak flow, temperature, urinalysis, blood glucose, central venous pressure and neurological observations. For each observation discussed, we provide a definition, the rationale, legal and professional issues, procedural guidelines and a guide to problem solving.

Observations

Definitions

The term ‘observation’ refers to the physical assessment of a patient, including assessment of wounds, intravenous therapy, wound drains, pain and vital signs collection and specialized assessments such as neurological observations (Zeitz and McCutcheon 2006). ‘Vital signs’ are traditionally used in the context of the collection of a cluster of physical measures, such as pulse, respiration, temperature and blood pressure, and more recently pulse oximetry.

Evidencebased approaches

Rationale

The taking of patient observations forms a fundamental part of the assessment process. The interpretation of the data from the assessment is vital in determining the level of care a patient requires, providing an intervention or treatment and preventing a patient deteriorating from an otherwise preventable cause (Wheatley 2006) (see Chapter 2).

Indications

Observations are usually undertaken:

to act as a baseline to help determine the patient’s usual range (Bickley and Szilargyi 2009)

to assist in recognizing if a patient’s condition is deteriorating or indeed improving (Kisiel and Perkins 2006).

Principles of care

Adult patients in acute hospital settings should have:

observations taken when they are admitted or initially assessed

a clearly documented plan which identifies which observations should be taken and how frequently subsequent observations should be done. This plan should take into consideration:

– the diagnosis

– plan for patient’s treatment

– any comorbidities which may affect their health.

(NICE 2007b)

All patients in hospital should have their observations taken at least once every 12 hours, unless specified otherwise by senior staff (NICE 2007b).

Methods of measuring and recording observations

To assist with the identification of critically ill patients and those at risk of deterioration, physiological scoring systems were introduced (Wheatley 2006). These include the Modified Early Warning System (MEWS) (see Figure 12.1), medical emergency team (MET) scoring and patientatrisk team (PART) score (DH 2001, Hodgetts et al. 2002). These scoring systems rely on nursing staff performing basic patient observations, that is, respiratory rate, heart rate, blood pressure, temperature and fluid balance (Wheatley 2006) and informing medical staff/outreach team of deviations from normal.

Figure 12.1 MEWS – Early Warning Scoring System (DH 2000).

There are many such scores in use although they should be used in conjunction with clinical judgement and a holistic assessment