Identifying a Deteriorating Patient Flashcards
What is the normal respiratory rate?
12-16 bpm (often omitted)
What does an increased respiratory rate indicate?
- Chronic respiratory conditions
- Acute respiratory conditions
- Cardiac causes
- Anxiety
- Pain
- Sepsis
- Increased temp
- Compensation
What does a decreased respiratory rate indicate?
- Sedatives/narcotics
- Altered consciousness
- Extreme fatigue
- Metabolic/neurological disorders
What are the normal blood oxygen levels?
97-99%
What does increased blood oxygen level indicate?
Excessive O2
What must be considered when looking at oxygen level in the blood?
Whether they’re being supplied with oxygen or not
What does decreased blood oxygen level indicate?
- Chronic respiratory disease
- Acute respiratory disease
- Cardiac/circulatory issues
- Neuromuscular disease
- Respiratory depression
What is normal heart rate?
60-100bpm
What does increased heart rate indicate?
- Hypoxaemia
- Hypotension
- Anxiety
- Sepsis
- Pain
- Fever
- Medication
What does decreased heart rate indicate?
- Arrythmias
- Cardiac disease
- Hypothermia
- Medication
- Vagal stimulation
What is normal blood pressure?
120/80 mmhg
What does increased blood pressure indicate?
- Renal/endocrine disease
- Anxiety
- Pain
- Head injury
- Medication
- Medication withdrawal/omission
- Atherosclerosis
What does decreased blood pressure indicate?
- Arrythmias
- Medication
- Cardiac disease
- Blood loss
- Dehydration
- Sepsis
What is normal temperature?
36.7 degrees
What does increased temperature indicate?
- Medication
- Exposure/exertion
- Infection
- Malignancy
- Inflammatory Disease
What does decreased temperature indicate?
- Exposure
- Metabolic issues
- Burns
- Medication
- Sepsis
- Neurological disease/impairment
- Malnutrition
- Trauma
- Shock
What is the frequency of monitoring required when the patient has a NEW score of 7+ ?
Continuous monitoring of vital signs
What is the frequency of monitoring required when the patient has a NEW score of 5-6 ?
Minimum 1 hourly
What is the frequency of monitoring required when the patient has a NEW score of 3 in a single parameter ?
Minimum 1 hourly
What is the frequency of monitoring required when the patient has a NEW score of 1-4 ?
Minimum 4-6 hourly
What is the frequency of monitoring required when the patient has a NEW score of 0 ?
Minimum 12 hourly
What clinical response is required when the patient has a NEW score of 7+ ?
- Registered nurse to immediately inform the medical team caring for the patient (at least at specialist registrar level)
- Emergency assessment by a team with critical care competencies, including practitioner(s) with advanced airway management skills
- Consider transfer of care to a level 2 or 3 clinical care facility (i.e.: higher-dependency unit or ICU)
- Clinical care in an environment with monitoring facilities
What clinical response is required when the patient has a NEW score of 5-6 ?
- Registered nurse to immediately inform the medical team caring for the patient
- Registered nurse to request urgent assessment by a clinician or team with core competencies in the care of acutely ill patients
- Provide clinical care in an environment with monitoring facilities
What clinical response is required when the patient has a NEW score of 3 in single parameter ?
- Registered nurse to inform medical team caring for the patient, who will review + decide whether escalation of care is necessary
What clinical response is required when the patient has a NEW score of 1-4 ?
- Inform registered nurse, who must assess the patient
- Registered nurse decides whether increased frequency of monitoring and/or escalation of care is required
What clinical response is required when the patient has a NEW score of 0 ?
Continue routine NEWS monitoring
Who are high risk patients?
Poor previous functional status
Smoking/alcohol history
Co-morbidities (and multi co-morbidities):
- Chronic lung disease
- Chronic heart disease
- Renal disease
- Liver disease
- Obesity
- Metabolic disorders
- Malignancy
- Neurological disease
What are other causes for concern of deterioration?
- Fluid balance changes
- Abnormal/worsening bloods
- Abnormal/worsening ABGs
- Retained secretions + weak cough/inability to DBE
- Uncontrolled post op pain
- Increasing medication/support to maintain obs
What is important to consider deterioration & high-risk patients early for?
- Prioritisation
- Involvement of other MDT members
- Escalation
What can early identification of a deteriorating patient impact on?
- Length of stay
- Quality of life
- Need for high care
- Mortality
- Functional status on D/C
