Five Situations to Consider in Securing Decisions in the Clinic
The ability to establish a prognosis for a patient is key in nursing and medicine. It is generally an ability that is very much determined by experience and intuition, which is ultimately the product of that experience actively worked on.
This quality of foreseeing the possible evolution of a patient is an added value to practice, because it allows the establishment of a diagnosis and treatment plan ‘adjusted’ to the foreseeable evolution. However, in order to increase the certainty of decisions, it is necessary to pay attention to clinical situations that could cloud the reasoning and lead to biased conclusions. Although there may be multiple and intricate circumstances, these five can assist in achieving greater safety in the clinical assessment of a patient.
FIRST SITUATION: Ruling out the presence of Sepsis
A patient with sepsis may present with non-specific symptoms such as obtundation or hypotension, and if not detected early, has a high mortality rate. This should always be kept in mind when making a decision in a patient with obtundation.
SECOND SITUATION: Thinking about metabolic disturbances
Ionic and metabolite alterations can cause a patient to show general deterioration, and if we do not take them into account, we may make the wrong decisions. Hypo- or hypernatremia, hypercalcaemia, increased blood bilirubin and elevated urea levels can contribute to patient deterioration.
THIRD SITUATION: CONSIDER THE INFLUENCE OF DRUGS
When a patient’s clinical situation changes acutely or subacutely, it is necessary to pay attention to the drugs the patient is taking, especially psychotropic drugs. There are certain forms of administration, such as patches, which may go unnoticed if they are not properly sought. Idiosyncrasies, such as the use of metamizole in Anglo-Saxons, must also be considered.
SITUATION FOUR: WORKING AS A TEAM WITH NURSING
Nursing reports on the evolution of the patient are key, given their proximity to the patient. The constants, including blood oxygenation values, are of the utmost importance.
FIFTH SITUATION: CONSIDER SERIOUS ‘SILENT’ CONDITIONS SUCH AS HAEMORRHAGE AND ISCHAEMIA.
There are certain serious situations such as ischaemia at any level, especially digestive, or internal haemorrhages, which, if not suspected, can produce a serious change in the patient’s clinical situation.
If we pay attention to these situations, our assessment of the patient, and our decision making, will be safer.
Author Lorenzo Alonso Carrión
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