Recognising and responding to deteriorating adult (MOD007213)
Summary
Summary Hypovolemia
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Course
Recognising and responding to deteriorating adult (MOD007213)
Institution
Anglia Ruskin University (ARU)
Notes to help ARU students for their 2nd year clinical speaking exam, MOD - Recognising and responding to deteriorating adult patient. These notes can also be accessed by non ARU students.
Notes explain:
ABCDE process specific for Hypovolemia
Pathophysiology of Hypovolemia
Signs and sympto...
Recognising and responding to deteriorating adult (MOD007213)
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Recognising and responding to the deteriorating adult patient.
Preparation document: Hypovolemia
, Discuss your Assessment, interventions and communication using ABCDE. (LO 1-2)
Tips: You should discuss normal and abnormal symptoms, a calculation of a NEWS and
aggregate score to identify the severity of acute illness and priorities of care.
Check area is safe, introduce myself (name and role), interact with patient (ask how the
patient is feeling), wash hands and wear PPE. Gain consent to treat and examine. Ensure
patient’s notes, observation and drug chat is easily accessible. Ask for another clinical
member of staff to assist if possible
NEWS
Airway Assessment: Intervention:
Is airway patent and Assess the patient
maintained? If airway is not patent, open the airway using head-tilt chin-
Can the patient lift manoeuvre. If suspected significant trauma with
speak? potential spinal involvement, perform a jaw-thrust instead.
Are there added Look for anything obstructing airway.
noises? Get airway adjuncts ready, Guedel (Unconscious) or NPA
Is there a see-sawing (Partly/fully conscious)
movement of the Reposition: If cardiac instability then lie flat with legs
chest and abdomen? elevated, if no cardiac involvement then in semi fowlers (30°
head-of-bed elevation)
Begin with 15litre of oxygen using non-rebreathe mask
(Crash call and CPR if no consciousness and no signs of life,
at any time)
Breathing Assessment: Intervention:
Look listen and feel Review RR
Regularly monitor spo2. Once in normal range, litre of
RR? (12-20bpm = oxygen can be reassessed to avoid co2 overdose
normal) Auscultate chest to identify any abnormalities such as
Tachypnoea consolidation
(>22bpm) or Percuss the chest to identify areas of dullness
Bradypnea Assess for bilateral movement to confirm regularity and
(<12bpm)? (The Royal rhythm of breathing
College of Physicians, If an infection is suspected (progressed to sepsis), IV
2017) antibiotics should be administered asap
If so, obtain sputum sample to understand causative
Spo2? (94-98% = organism and its antibiotic sensitivities
normal or 88-92% if (Crash call and CPR if no consciousness and no signs of life,
co2 retention) at any time)
Hypoxia (<92%)?
Is breathing
laboured? (Using
accessory muscles)
Circulation Assessment: Intervention:
HR? (51-90bpm = Monitor HR and BP
normal) Tachycardia Insert 2 wide bore intravenous cannulas (14G or 16G)
(>100bpm) or Urgent fluid resus: 500ml bolus 0.9% Sodium chloride over
Bradycardia less than 15mins and then reassess. Repeat administration
(<60bpm)? (British of fluid boluses up to 4x (2000ml) and then reassess for
Heart Foundation, fluid overdose (National institute For Health And Care
2022) Excellence, 2017)
Correct underlying cause: If active bleeding, apply direct
BP? (90/60 – 120/80 pressure and escalate to 2222 for assistance.
= normal, for over Collect bloods: FBC, U&Es, LFTs, ABG, Group and save and
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