The nursing process

The purpose of this essay is to discuss the importance of assessment. The author will firstly discuss the importance of nursing assessment. The author will then briefly discuss the role of the nurse in assessing and identifying risk factors in relation to infection control and deep vein thrombosis (DVT). This will be followed by an in depth discussion of pain assessment and the analysis of a pain assessment tool, followed by a conclusion.

Assessment is the first stage of the nursing process and begins with the collection of information about a patient (Hinchliff et al, 2003). Assessment commences as soon as a nurse meets a patient for the first time and may be a continuous process depending on a patients’ condition and needs (Hinchliff et al, 2003). The Nursing & Midwifery Council (NMC, 2002) Code of Professional Conduct state that patients’ information gained at assessment should be treated as confidential.

Infection is the invasion of the body by pathogenic microorganisms and their duplication, which can lead to tissue damage and disease (Heath, 2002). The chain of infection consists of an infectious agent, reservoir, portal of exit, mode of transmission, portal of entry and host (Filetoth, 2003). There are various infections that can effect a patient namely urinary tract infection and Methicillin Resistant Staphylococcus Aureus MRSA. If the chain remains intact an infection will develop, it is therefore important to break the chain to prevent an infection from occurring. It is therefore important for a nurse to conduct a thorough assessment.

The nurse should establish the source of infection and how it spreads. It is important to establish if there are any further risk factors and what the mental and physical condition is of the patient. The nurse should also consider if other patients or staff is at risk. There are various risk factors that make some people more at risk of infection then others these could include age, diabetes, surgery and certain illnesses such as cancer. Universal precautions should then be followed to break the chain of infection (McCulloch, 2000).

Universal precautions include washing of hands, disposing of sharps and soiled linen in the correct manner. If a patient has a serious infection like TB or a hospital acquired infection like MRSA then local hospital policies should be followed. Assessment and identifying risk factors of infection is therefore important for nurses, however assessment includes various areas including the risk of developing a DVT.

Deep vein thrombosis is due to the formation of a blood clot in a deep vein (Autar, 2003). A DVT can be formed due to three reasons known as Virchows Triad (Autar, 2001). These are of venous circulation, hypercougability and injury to veins (Autar, 2001). It is especially dangerous if the blood clot reaches the lungs causing a pulmonary embolus. It is therefore important to form an assessment to prevent a DVT from occurring. A common assessment tool used is the Aurtur scale.

The Autar DVT risk assessment scale takes into account the patients age, mobility, trauma, body mass index, special risk category and surgical intervention to assess a patients risk of developing a DVT. There are certain signs and symptoms that can identify a DVT developing. These include an abnormal swelling of the limb and a warm feeling. It feels tender and is painful, the veins are dilated and the limb affected can change colour and pyrexia (Elliot, 2001).

There are various ways in preventing a DVT from occurring namely to encourage mobility as it keeps the veins in the legs functioning and therefore reducing the risk of venous stasis (Day, 2003). Passive exercises for those patients that are immobile as it helps with blood circulation and therefore reduces the risk of a DVT forming. Deep breathing as it provides oxygen to the blood cells and anti-coagulants to reduce clotting.

Anti-embolism stockings could be worn to speed up the blood flow by graduated compression or a venous plexus foot pump could be provided to squeeze the sole of the feet to help with circulation of blood in immobile patients. Anti coagulant medication such as warfarin or heparin could also be administered as it disrupts the clotting process (Merli, 2003). There are various ways in which a DVT can be detected namely by a venogram, ultrasound or MRI (Autar, 2001).

The international association for the study of pain (2001) state that pain is “an unpleasant, sensory and emotional experience associated with actual or potential tissue damaged or described in terms of such damage”. In 1965 Melzack & Wall proposed the Gate Control Theory of pain. Their theory suggests that mechanisms in the spinal cord can block pain impulses so that they do not reach the brain; this is called gating. The gate can be opened by the release of excitatory neurotransmitter chemicals and can be closed by the release of inhibitory neurotransmitters and neuromodulators (Beretta, 2003)

It is important to assess pain as it gives patients the opportunity to express their pain. It also gives the nurse the opportunity to show an interest in the patients’ pain and therefore building a therapeutic relationship. Assessing pain gives the patient an active role in his or her own pain management. By assessing and documenting pain, provides documented evidence of care delivered and helps other health professionals in caring for the same patient (Main & Spanswick, 2000).

The role of the nurse in pain assessment is extremely important. The nurse should assess the pain and validate the pain and decide on the best course of action to take. It is the nurses’ role to provide the patient with information about the pain and management therapies. There are many factors that influence the pain assessment process, for example the location of pain, intensity of pain, duration of pain and the type of pain experienced.

Other factors that can influence the pain assessment include the patients’ mental state, physical state and emotional state (Colley & Crouch, 2000). It is essential to use pain assessment tools to effectively assess a patients’ level of pain. There are numerous pain assessment tools available and it is up to the nurse to decide which one would be appropriate to use. Some pain assessment tools include the numerical rating scale, faces rating scale, visual analogue scale etc (Krohn, 2002). The author will analyse the numerical rating scale.

The numerical rating scale is a verbal rating scale that uses numbers from one to ten to verbalise pain levels. One being the least pain and ten being the worst pain. It is effective as the patient is able to verbalise to the nurse which amount of pain they are suffering. It does however have its limitations. It is unable to describe the type of pain or location of pain (Schofield, 2003). The patient with learning difficulties or unbearable pain would be unable to make use of the scale. Also those patients that have hearing or vision impairments or non-English speaking patients would have difficulties in using the numerical rating scale.

It is therefore important for the nurse to assess a patients’ level of pain in other ways as well. This could include verbalisation and observing the patients’ facial expression. It is also possible to observe a patients’ body language and activity levels to assess the amount of pain that they are in. The management of pain can be achieved in various ways. Pharmacologically by using an analgesic ladder. For chronic pain such as cancer the world health organisation (WHO, 2002) analgesic ladder can be used. Pain can also be managed non-pharmacologically for example by positioning, massage, distraction, giving information and listening.

Pain has various effects on a patient. Physiologically it can affect their heart rate, blood pressure and respiration rate. It could also affect their mobility and loss of function. Psychologically it can bring on fear, anxiety, depression, irritability and anger (Davis, 2000). It is therefore important for nurses to carry out a thorough assessment of a patients pain to promote their well-being. It should also be noted that pain is whatever the patient says it is. In conclusion it can be seen that a thorough assessment is needed in every aspect of patient care. By conducting a thorough assessment a nurse is able to determine what a patient can and cannot do and also to identify risk factors. By assessing a nurse is able to set short and long term goals for a patient and by completing the nursing process.

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