ASSIGNMENT

Assignment

Assignment

Part One: To critically analyze and discuss a holistic patient assessment including history taking and physical examination of a limb(lower limb)of a patient with osteoarthritis of the knee.

The health care system that has the ability to provide excellent preventative measures, diagnosis, treatment and care to people. But all of this depends upon patient access to not only doctors who can prescribe treatments, but to skilled nurses whose care is essential to recovering and maintaining the well-being of patients.

Patients who would have been admitted to the hospital 15 years ago are now routinely denied admission. Those cared for in the hospital are more acutely ill than ever before, and they are often discharged while they are still in need of nursing care. Because of their greater degree of illness, patients today need more attentive nursing care. Yet, in hospitals we often have too few nurses to manage their care on busy nursing units. This has made it difficult for me and thousands of other nurses like me to ensure that patients get the care that they deserve, the best care that we know how to provide.

This is what it is like to be a nurse in the hospital today. As I help an elderly woman from the wheelchair into a hospital bed, my assessment is quick and easy--moderately severe dehydration, fever, productive cough, dizziness, nausea. I immediately hang intravenous fluids, treat the fever and nausea, and move her to a room adjacent to the nurses' station where she can be observed frequently and receive help quickly if she tries to get out of bed. Her attending physician comes in and shares his frustrations. "She's been in the emergency room twice over the past weekend. It's probably just bronchitis, but I begged them to admit her this time because I was afraid if they sent her home again, she would die," this doctor told me.

When did we, as a system, start to ignore the all-too-evident needs of patients when they fail to fit into tidy medical admission categories? How much professional nursing time will be spent, not on treating this woman's very real health problems, but on ensuring that the wording in the chart will help the hospital to be reimbursed for this care? The answer: too much!

I spend 40 minutes in conversation with a wakeful patient in the middle of the night. Admitted because she hemorrhaged after treatment of a recently diagnosed tumor, she is unable to sleep while she wonders what will happen to her family now that they have entered the unfamiliar and uncertain terrain of cancer. How will her young children cope with her illness? How can she help her husband manage his anger, depression and grief at this catastrophe? Her nurses and physicians have aggressively managed and stabilized her physical condition over the past two days, but nobody has had a chance to help her understand what this will mean to her life. Our conversation helps her to understand her current and future treatment ...