Holistic Patient Health Assessment Importance

Introduction

The health assessment of the patient is regarded as a primary step to be performed in nursing to identify the health problems or risk being faced by the patient as well as medical needs of them to deliver them satisfactory and high-quality care. It is also important to execute effective health assessment so that the nurses can understand the way care plan is to be framed for the patient to ensure good health outcome (Nelson et al. 2015). In this essay, holistic assessment of patient J is to be done for identifying the specific health condition that is most intensely disrupting the normal living of the individual.

Consent and Confidentiality

The informed consent means the patients have proper information regarding their treatment to take decision about their care whereas confidentiality means keeping the health as well as personal information of the patient in a private manner (Dheensa et al. 2016). The informed consent of the patient is required by the nurses to provide them care is the rule mentioned under section 4.2 of “Prioritise People” (NMC, 2015). Thus, the nurses before executing holistic assessment of patient J provided her detailed information about the cause and way the assessment is to be executed and the way information from the assessment is to be used based on which consent was collected. The management of the confidentiality and privacy of the patient is mentioned in the NMC Code of Practice under section 5 of “Prioritise People” (NMC, 2015). Thus, the pseudonym “J” is used to indicate the patient to ensure her confidentiality as disclosing the name could lead to expose the identity of the patient, in turn, violating confidentiality and privacy.

Patient Background

Patient J who was 88 years old was reported to be admitted to the oncology ward prior to 4 weeks before the execution of the holistic assessment. In the previous year, she was reported to be diagnosed with primary breast cancer and was admitted to the ward due to problem with hypoxia and dyspnoea as a result of lung metastasis. The dyspnoea is laboured or difficult breathing which leads to hypoxia that is a condition in which certain region or part of the body is oxygen deprived as required amount of oxygen to reach the body tissues fails to happen due to troubled breathing (Yamaguchi et al. 2018; Peeters et al. 2015). Thus, the holistic assessment was made for patient J to get identify what health constraints are presently faced by her due to dyspnoea and hypoxia and determine the actual health condition and needs to be fulfilled to ensure her better health condition. The assessment was executed within a week and information was collected by accessing the medical history and reports of the patients as well as through clinical observations and assessment.

Explanation of Holistic Assessment

Holistic Assessment in nursing acts as foundation of patient care where the nurses identify the emotional, physical, practical, social and spiritual demands of the service users to ensure effective care resources are arranged to fulfil their demands for accomplishing satisfactory care (Kotronoulas et al. 2017). The holistic assessment of the patient is executed as it is the first step to be taken for the patient in the nursing process for determining their actual health condition. The Roper-Logan-Tierney model is to be applied to perform the holistic assessment for patient J and the model is selected due to its flexibility to be used in any nursing field to assess the patient in holistic manner. In addition, the model is used for making the assessment to determine the independence and personal ability of the patient to perform her daily activities (Williams, 2017). Thus, this model is to be used for holistic assessment of patient J because it helps the nurses to get informed about vital health condition and needs of J to be improved and fulfilled. In the appendix, the detailed holistic assessment of patient J is presented.

Analysis of Patient’s Assessment

According to Roper-Logan-Tierney model, breathing is the key activity of living of the patient (Holland and Jenkins, 2019). Since J’s main health problem was dyspnoea and hypoxia, thus general observation regarding her breathing efficiency was made to analyse the intensity of her condition. In general observation, at first, the respiratory rate of patient J at rest was performed by counting number of breaths for one minute by looking at her chest movement. The normal respiratory rate of a healthy adult is 12-18 breaths per minute (Fang et al. 2016). However, the number of breath per minute in patient J was 21 that is more than normal ensuring the patient is suffering from shortness of breath as breathing rate increases when an individual tries to pump in more oxygen. The heart rate of patient J was determined for understanding the impact of breathing problem due to dyspnoea and hypoxia have on her cardiac performance and it is checked by using a stethoscope. The normal heart rate of an adult human is between 60-80 beats (Hopkinsmedicine, 2018). However, in case of patient J is measured to be 94 beats per minute which indicate the patient has an increased cardiac output due to breathing trouble. The limitation of the cardiac performance test through a stethoscope is that manual error may arise which would lead to wrong heart rate measurement (Gintant et al. 2016). In order to assess the breathing condition of the patient J peripheral and central observations are made. In the peripheral observation, the hands and feet of patient J are checked to determine whether shortness in breathing has lead her develop cyanosis. Cyanosis is a condition in which bluish colour appears on the skin as well as on mucous membranes due to lack of oxygen in the body (Sayk et al. 2018). In the peripheral observation, no blue colouration of feet or hands was found on J ensuring no peripheral cyanosis was present. In central observation, the mucous membranes of the mouth, lips and tongue of patient J was checked. In central cyanosis, blue or purple coloration of tongue, lips and mucous membranes is seen among individuals (Muthialu et al. 2016). In case of patient J, no such colouration was seen ensuring no central cyanosis was present. Further, the chest wall tenderness and movement are observed in patient J in regard to her breathing trouble. It was reported that she has a tight chest and showed paradoxical respiration. The paradoxical respiration in opposite of normal chest wall movement in which during inspiration all parts of the lungs inflates and during expiration the lung balloons out (Ayed et al. 2018). These observations indicate that patient J was facing breathing trouble due to dyspnoea and hypoxia. During the breathing rate assessment, the depth and pattern of breathing of patient J were also examined. The depth and pattern of breathing are executed to understand the extent of difficulty in respiration a person is facing due to breathing problem (Tipton et al. 2017). The pattern of breathing in patient J is determined by looking at her chest movement which showed that she is taking irregular pauses to respire which indicates that she is suffering from breathing trouble. The depth of the breathing in patient J is measured by using a spirometer. The Spirometer is the apparatus for measuring air volume that is expired or inspired by lungs (Young et al. 2015). The normal depth of the breathing of any adult is 500ml (Firstresponder, 2018). However, in patient J it was reported to be 400ml which is lower than normal indicating her failure to breathe properly. The advantage of the spirometer in breathing assessment is that proper tidal volume or depth of breathing of the patient can be determined easily but its limitation includes that the test through the instrument is time taking and may raise an error in results creating wrong health assessment of the patient (Alcaide et al. 2017).

The sputum test and chest X-ray is done for patient J to assess her breathing condition due to lack of time. In patients with breathing issues, the sputum test is important as it helps to identify if any bacterial growth in the lower respiratory tract has occurred due to which the breathing trouble is actually raised (Dudgeon, 2015). The Chest X-ray is able to inform any blockage in the airway that is causing breathlessness or any infection has been raised in the respiratory tract that is initiating breathing trouble (Nagata et al. 2015). However, the limitation with the test is that X-rays are harmful to the patient as it leads them to develop cancer (Meriggi, 2018). In patient J, she is already suffering from breast cancer and lung metastasis and thus in this condition, the chest X-ray would have been effective to understand to the extent the metastasis has spread to the lungs which are bothering J to face breathing problem. In order to further analyse breathing condition, the periphery capillary oxygen saturation is then determined for patient J by using pulse oximeter after making general observation of her breathing condition. The pulse oximeter is used for detecting capillary oxygen saturation (SpO2) level to estimate the amount of oxygen content in the blood (Jubran, 2015). This acts as strength to detect the condition of the patient and the oxygen content that are reaching the tissues while experiencing hypoxia. However, the limitation of using pulse oximeter in detecting SpO2 level is that the device does not use calibrations and in case perfusion is lowered and pulse amplitude is small then the signal received will be decreased. This will lead the device to provide an error reading of SpO2 level (Bickler et al. 2017). The other limitation of pulse oximeter is that motion artefact is able to cause interference with detection and interpretation of signals by pulse oximeter due to unstable waveform and it cannot be used for patients with irregular cardiac rhythms as the device does not have the capacity to average the waveform of signal within the amount time set (Lee et al. 2016). Patient J was already facing hypoxia and dyspnoea which have the ability to reduce perfusion as well as create irregular cardiac rhythms. Thus, the limitations of the pulse oximeter in detecting SpO2 level in patient J makers it contradictory in explaining whether or not the mentioned level was right. The normal SpO2 levels in an adult remain between 95-100% (Firstresponder, 2018). However, the SpO2 level of patient J was 90% which is lower than normal indicating shortness of breath.

The blood gas test is being performed for patient J to determine her lung performance as result of dyspnoea and hypoxia. As asserted by Jerzak et al. (2017), blood gas tests are executed to identify the efficiency of the lungs to be able to move oxygen in the blood and remove carbon dioxide out from the blood. The blood gas test results of patient J shows she has blood pH 7.1, bicarbonate 34 milliequivalents/l and partial pressure of carbon dioxide 44mm Hg. The normal blood gas test of an adult human indicates that blood pH is to be 7.38-7.64, bicarbonate 22-28mm Hg and partial pressure of carbon dioxide 38-42mm Hg (Medlineplus, 2018). The results indicate that the blood pH is low and bicarbonate that is used to maintain blood alkalinity is high which has led the blood to acidic in nature indicating lack of oxygen in blood (Kulkarni et al. 2016). Thus, patient J breathing can be assessed to be inadequate to maintain proper oxygen in the blood. The limitation of blood gas test is that it fails to reflect the degree to which any abnormality is able to affect the patient and it cannot identify any specific diagnosis (Uyanik et al. 2015). Thus, the test is unable to inform degree of abnormal breathing experienced by patient J or specify if she is actually suffering from dyspnoea and hypoxia and not from other diseases. The patient J is seen to be in palliative care as she is suffering from lung metastasis, chest drain and other condition with dyspnoea and hypoxia as major issues. Thus, further examination of J is made by focussing on daily activities of living mentioned in the Roper-Logan-Tierney model to make holistic assessment regarding the way her breathing problem is interfering with her daily activities. According to the Roper-Logan-Tierney model, eating and drinking are vital activity of living for a patient as it ensures proper intake of nutrition and maintaining proper fluid content in the body (Williams, 2017). The individuals with dyspnoea and hypoxia often experience issues with eating and drinking as they feel shortness of breath (Yang et al. 2016). Thus, this aspect is assessed for patient J to which she reported to be drinking and eating normally without any aid even suffering from dyspnoea and hypoxia indicates that the breathing trouble is not much intense due to which it has still not interfered with her eating habits. The Roper-Logan-Tierney model indicates that elimination is essential to remove wastes from the body (Holland and Jenkins, 2019). It is seen that hypoxia and inflammatory bowel disease (IBD) arte inter-related (Colgan, 2016). Thus, the elimination activity of patient J is executed to which she reported to show easy bowel movement even after having hypoxia which indicates that she is not affected by IBD.

The patients with hypoxia and dyspnoea face trouble with dressing and washing as a result of shortness of breath (Fan et al. 2016). The Roper-Logan-Tierney model informs that washing and dressing activity is required for the patients to be performed to ensure their hygiene and proper living (Williams, 2017). Therefore, the assessment regarding washing and dressing is executed for patient J and she reported to be facing issue with washing and dressing. This indicates that due to hypoxia and dyspnoea she is facing shortness of breath which has interfered with her ability to personally dress and wash. According to the Roper-Logan-Tierney model, controlling temperature of the body is essential to maintain homeostasis (Holland and Jenkins, 2019). The individuals in palliative care are often reported to have high body temperature that leads them to face breathing trouble (Golubnitschaja, 2017). Thus, assessment of temperature is of Patient J is executed to which she reported having normal body temperature meaning her body temperature is not causing her shortness of breath. According to Roper-Logan-Tierney model, mobilisation is important activity of a person (Williams, 2017). The people with hypoxia and dyspnoea face issues with mobilisation due to shortness of breath (Buss and Dachs, 2018). Since patient J is suffering from similar condition her mobilisation ability is assessed which informs that she faces issues and requires with movement indicating her breathing trouble has made her face issues with mobilisation. According to the Roper-Logan-Tierney model, working and playing and expressing sexuality are important parts of living (Holland and Jenkins, 2019). In patients with dyspnoea and hypoxia, due to breathing trouble, they are unable to play and work (Kan et al. 2016). Since J is suffering from similar condition, the working and playing efficiency of her is assessed where it is found that she do not play and work now more often. However, the assessment mentions that she is retired and confined to the hospital; bed thus she cannot work and play and these aspects of her activity of living are not influenced by her breathing trouble. The Roper-Logan-Tierney model informs that sleeping is essential to ensure rest to the body and dying is another key activity of living (Williams, 2017). In case of patients with hypoxia and dyspnoea, it is seen that they cannot sleep continuously due to shortness of breath (Campos-Rodriguez et al. 2018). Patient J suffering from similar condition where she reported due to shortness of breath she has interrupted schedule at night which can lead to assessed that her breathing trouble in interfering with her sleeping ability.

Conclusion

The discussion informs that the Roper-Logan-Tierney model is implemented to execute holistic assessment of patient J as it informs about the key twelve activity of living to be focused to successfully execute the examination. The breathing activity is mainly assessed since the key problem experienced by the patient is shortness to breathe due to dyspnoea and hypoxia as a result of lung metastasis due to breast cancer. The breathing assessment is done by executing general observations and clinical examination through blood gas test, spirometer test, oximeter test and others. The other aspects of the activity of living that are influenced to be harmed by dyspnoea and hypoxia in patient J are executed where the results inform that the condition has interfered with her sleeping, washing and dressing and mobilising activity.

References

Alcaide, A.B., Sanchez-Salcedo, P., Bastarrika, G., Campo, A., Berto, J., del Mar Ocon, M., Fernandez-Montero, A., Celli, B.R., Zulueta, J.J. and De-Torres, J.P., 2017. Clinical features of smokers with radiological emphysema but without airway limitation. Chest, 151(2), pp.358-365.

Ayed, A.B., Hentati, A., Abid, W., Ghorbel, I. and Nouri, K., 2018. Interest of Myocutaneous Plasty after Extended Sternal Resection. J Pulm Respir Med, 8(447), p.2.

Bickler, P.E., Feiner, J.R., Lipnick, M.S., Batchelder, P., MacLeod, D.B. and Severinghaus, J.W., 2017. Effects of acute, profound hypoxia on healthy humans: implications for safety of tests evaluating pulse oximetry or tissue oximetry performance. Anesthesia & Analgesia, 124(1), pp.146-153.

Buss, L.A. and Dachs, G.U., 2018. The Role of Exercise and Hyperlipidaemia in Breast Cancer Progression. Exercise immunology review, 24.pp.34-61.

Campos-Rodriguez, F., Cruz-Medina, A., Selma, M.J., Rodriguez-de-la-Borbolla-Artacho, M., Sanchez-Vega, A., Ripoll-Orts, F., Almeida-Gonzalez, C.V. and Martinez-Garcia, M.A., 2018. Association between sleep-disordered breathing and breast cancer aggressiveness. PloS one, 13(11), p.e0207591.

Colgan, S.P., 2016. Targeting hypoxia in inflammatory bowel disease. Journal of Investigative Medicine, 64(2), pp.364-368.

Dheensa, S., Fenwick, A. and Lucassen, A., 2016. ‘Is this knowledge mine and nobody else's? I don't feel that.’Patient views about consent, confidentiality and information-sharing in genetic medicine. Journal of medical ethics, 42(3), pp.174-179.

Fan, Y., Liu, L., Fang, K., Huang, T., Wan, L., Liu, Y., Zhang, S., Yan, D., Li, G., Gao, Y. and Lv, Y., 2016. Resveratrol Ameliorates Cardiac Hypertrophy by Down‐regulation of miR‐155 Through Activation of Breast Cancer Type 1 Susceptibility Protein. Journal of the American Heart Association, 5(4), p.e002648.

Fang, B., Lane, N.D., Zhang, M., Boran, A. and Kawsar, F., 2016, June. BodyScan: Enabling radio-based sensing on wearable devices for contactless activity and vital sign monitoring. In Proceedings of the 14th Annual International Conference on Mobile Systems, Applications, and Services(pp. 97-110). ACM.

Gintant, G., Sager, P.T. and Stockbridge, N., 2016. Evolution of strategies to improve preclinical cardiac safety testing. Nature reviews Drug discovery, 15(7), p.457.

Golubnitschaja, O., 2017. Feeling cold and other underestimated symptoms in breast cancer: anecdotes or individual profiles for advanced patient stratification?. EPMA Journal, 8(1), pp.17-22.

Holland, K. and Jenkins, J. eds., 2019. Applying the Roper-Logan-Tierney Model in Practice-E-Book. Elsevier.

Jerzak, K.J., Laureano, M., Elsharawi, R., Kavsak, P., Chan, K.K., Dhesy-Thind, S.K. and Zbuk, K., 2017. Targeted metabolomics in colorectal cancer: a strategic approach using standardized laboratory tests of the blood and urine. Hypoxia, 5, p.61.

Kan, C., Vargas, G., Pape, F. and Clézardin, P., 2016. Cancer cell colonisation in the bone microenvironment. International journal of molecular sciences, 17(10), p.1674.

Kotronoulas, G., Connaghan, J., Grenfell, J., Gupta, G., Smith, L., Simpson, M. and Maguire, R., 2017. Employing patient-reported outcome (PRO) measures to support newly diagnosed patients with melanoma: Feasibility and acceptability of a holistic needs assessment intervention. European Journal of Oncology Nursing, 31, pp.59-68.

Kulkarni, P., Haldar, M.K., You, S., Choi, Y. and Mallik, S., 2016. Hypoxia-responsive polymersomes for drug delivery to hypoxic pancreatic cancer cells. Biomacromolecules, 17(8), pp.2507-2513.

Lee, H., Ko, H. and Lee, J., 2016. Reflectance pulse oximetry: Practical issues and limitations. Ict Express, 2(4), pp.195-198.

Muthialu, N., Joshi, S., Hoskote, A. and Bhole, V., 2016. Rare cause of central cyanosis: right pulmonary artery to left atrial fistula. Interactive cardiovascular and thoracic surgery, 23(5), pp.839-840.

Nagata, Y., Hiraoka, M., Shibata, T., Onishi, H., Kokubo, M., Karasawa, K., Shioyama, Y., Onimaru, R., Kozuka, T., Kunieda, E. and Saito, T., 2015. Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 non-small cell lung cancer: Japan Clinical Oncology Group Study JCOG0403. International Journal of Radiation Oncology* Biology* Physics, 93(5), pp.989-996.

Peeters, D.J., Brouwer, A., Van den Eynden, G.G., Rutten, A., Onstenk, W., Sieuwerts, A.M., Van Laere, S.J., Huget, P., Pauwels, P., Peeters, M. and Vermeulen, P.B., 2015. Circulating tumour cells and lung microvascular tumour cell retention in patients with metastatic breast and cervical cancer. Cancer letters, 356(2), pp.872-879.

Tipton, M.J., Harper, A., Paton, J.F. and Costello, J.T., 2017. The human ventilatory response to stress: rate or depth?. The Journal of physiology, 595(17), pp.5729-5752.

Uyanik, M., Sertoglu, E., Kayadibi, H., Tapan, S., Serdar, M.A., Bilgi, C. and Kurt, I., 2015. Comparison of blood gas, electrolyte and metabolite results measured with two different blood gas analyzers and a core laboratory analyzer. Scandinavian journal of clinical and laboratory investigation, 75(2), pp.97-105.

Yamaguchi, T., Matsuda, Y., Matsuoka, H., Hisanaga, T., Osaka, I., Watanabe, H., Maeda, I., Imai, K., Tsuneto, S., Wagatsuma, Y. and Kizawa, Y., 2018. Efficacy of immediate-release oxycodone for dyspnoea in cancer patient: cancer dyspnoea relief (CDR) trial. Japanese journal of clinical oncology, 48(12), pp.1070-1075.

Young, R.P., Duan, F., Chiles, C., Hopkins, R.J., Gamble, G.D., Greco, E.M., Gatsonis, C. and Aberle, D., 2015. Airflow limitation and histology shift in the National Lung Screening Trial. The NLST-ACRIN cohort substudy. American journal of respiratory and critical care medicine, 192(9), pp.1060-1067.