Sample Nursing Case Analysis of Increased Respiratory Rate and Chest Pain

Abstract

This paper examines a critical incident encountered in a local community health setting involving a patient experiencing internal bleeding in the brain. The incident includes the health outcomes the patient presented during her stay at the ward, including chest pains and increased respiratory rate. A root cause analysis of the incident, leadership style implemented, ethical principles integrated into managing the situation, ethical theories, and the resolution of that particular event are presented. A resolution to the incident is presented, involving a detailed examination of patients to ensure that some of the conditions that can be life-threatening are detected and managed early.

 

Critical Incident

Discussion of Critical Incident: Root Cause Analysis of Increased Respiratory Rate and Chest Pain in a Patient Experiencing Internal Bleeding in the Brain

A critical clinical incident involving a patient encountering internal bleeding in the brain had been experienced in a local community health setting a few years ago. The client was an inpatient at the hospital’s ward for about ten days after she had been diagnosed with internal brain bleeding. This condition had left her with left-sided weakness and aphasia. This incident occurred one afternoon when a nurse intern was visiting and making routine observations. The nurse intern was tasked with conducting routine observations on the health status of patients within the ward.

That afternoon, the nurse intern had conducted a routine observation on Mary, the patient experiencing internal brain bleeding, and he noticed that she was in stable condition. After proving that the patient was in stable condition, the nurse intern moved to the next patient to perform routine observation of the client’s condition. While conducting routine observation of the other patient, Mary’s son, who was visiting, asked the nurse intern to reexamine his mother, who reported having pain in her chest. After a thorough examination, the nurse intern found out that the patient’s condition was deteriorating. The nurse intern informed his supervisor about the patient’s situation, and he was instructed to present his findings to the physician while the nurse supervisor administered Glyceryl Trinitrate (GT) spray to the client. Glyceryl Trinitrate is a spray used to relieve patients of angina or chest pain. The physician then assessed the patient’s situation and noticed that she had an increased respiratory rate, a sign that the nurse intern had not noticed earlier.

The physician engaged the intern’s supervisor and nurse regarding the analysis of the cause of the incident. The root cause analysis was to determine what might have prompted the situation, why it happened, and what could be done to prevent reoccurrence in the future. After a thorough assessment of the patient’s situation, the three-member health team found out that she had an increased respiratory rate and chest pains due to elevated blood pressure. The elevated blood pressure influenced her systolic and diastolic body processes as well the arterial pressure; thus, contributing to outcomes she demonstrated. The physician instructed the nurse intern to administer 5mg of morphine, 15 liters of oxygen, continue applying GT spray to relieve the patient of the pain and relax and widen her blood vessels to ensure proper respiration.

Leadership Theory Applied to Critical Incident

Various leadership theories can be applied to the incident, including democratic leadership theory. Democratic leadership style is whereby members of a given team or group collaborate in making informed decisions (Lestari & Prastyawan, 2018). According to Lestari and Prastyawan (2018), this type of leadership contributes to high productivity and increased morale among a particular group. During the critical incident, the democratic leadership style was important in handling the patient’s situation. The physician adopted some procedural steps that helped the health providers in conducting the root cause analysis of the incident. Every member was included in the decision-making process to determine the best way to help relieve the patient of the pain and reduce the arterial pressure that contributed to the increased respiratory rate. The physician instructed the nurse intern to administer 5mg of morphine and GT spray to the patient to achieve this. The results of the root cause analysis and the procedural steps that were adopted helped to relieve the patient of the pain and regulate her increased respiratory rate.

Ethical Implications of the Critical Incident

The health providers leveraged three principles of healthcare ethics in making informed decisions. One of the ethical principles adopted was beneficence. The principle of beneficence states that healthcare providers must do all they can to benefit a patient in each situation. The healthcare providers tried to do all they could to ensure that the patient could be relieved of pain, and her respiratory rate is regulated to a normal level by administering GT spray and 5mg of morphine. The ethical principle of non-maleficence holds that healthcare providers must consider whether the decisions they make may harm a patient (Casale, 2016). Regarding the incident, the decisions the health providers made did not harm the patient as she demonstrated better health outcomes, including being relieved of the chest pains and resuming normal respiratory rate. The principle of justice maintains that there should be an element of fairness in all medical decisions (Casale, 2016). This ethical principle was demonstrated when the health providers all participated in determining the root cause analysis of the incident and coming up with the best medical interventions for the patient’s situation. Although the three principles were applied to the situation, the incident might have occurred due to a lack of consideration of the principle of autonomy during the patient’s admission. The patient was not involved in various medical decision-making processes; thus, some of the conditions that she had, such as high blood pressure, were not identified earlier.

Ethics Theory Discussion:  Utilitarian vs. Deontological Ethics

If moral dilemmas arise due to conflict between duties or obligations and consequences, two ethical theories, utilitarian and deontological ethics, would be essential in guiding a healthcare provider’s decision-making processes. Utilitarianism asserts that the only way an action can be judged morally correct is when it maximizes the best consequences and happiness to the greatest number of people. This ethical theory includes two aspects: act utilitarianism and rule utilitarianism. Act utilitarianism entails decision-making processes, which focus on the analysis of each patient’s situation or case without examining evidence or experience. Rule utilitarianism entails decision-making processes guided by the existing evidence (Miller, 2014). In contrast, the deontological theory states that healthcare providers should adhere to their duties and obligations when engaged in decision-making processes appropriate for a patient (Lazar, 2019). The theory asserts that the aim should be to improve a patient’s health status.

Rule utilitarianism and deontological theories were implemented in making informed medical decisions. Rule utilitarianism was demonstrated when the health providers adopted various medical procedures to establish the root of the patient’s situation. The aim was to determine the factors that were contributing to the patient’s discomfort and prevent such an incident from occurring again. The deontological theory was demonstrated when the medical decisions were made based on the patient’s situation to ensure she was comfortable.

Resolution, Analysis, and Legal Implications of the Critical Incident

Performing root cause analysis of the incident aimed at determining factors that contributed to the patient’s situation and help protect her from adverse health outcomes. The resolution for the incident entailed engaging every patient in clinical decision-making processes to ensure they share information related to the additional conditions they live with, which may go undetected. The situation was experienced because health providers who admitted the patient did not adhere to the ethical principle of autonomy, which requires clients to be engaged in clinical decision-making processes. As a result, the patient’s high blood pressure went unnoticed as the son later claimed that the mother had been earlier diagnosed with a similar condition. The legal implications related to the incident are valid as the health providers who admitted the patient into the ward did not fully examine the client; thus, leading to other conditions, such as high blood pressure, that remained undetected. The undetected, high blood pressure could have had fatal implications had there not been any health professional nearby. Therefore, legal actions should have been taken against the health professionals who did not fully assess the patient’s condition.

Conclusion

This paper investigated a critical incident that was encountered in a local community involving a patient experiencing internal brain bleeding. The patient demonstrated discomfort after being in the ward for about ten days. Chest pains and increased respiratory rate triggered the incident. After conducting of root cause analysis of the incident, the patient’s discomfort was found to have been caused by high blood pressure. Therefore, various ethical principles, including beneficence, non-maleficence, and justice, and theories, such as utilitarianism and deontological theory, guided our clinical decision-making processes. The leadership style adopted throughout the decision-making process was the democratic leadership technique. The resolution to the incident entailed a detailed examination of a patient’s condition to ensure that some issues, which may harm a patient during the recovery period, are detected early and effectively managed. If it had been determined that the patient had high blood pressure when she was admitted, the critical incident could have been avoided through close monitoring of the condition.

 

 

References

Casale, K. R. (2016). Ethical and Legal Principles. Psychiatric-Mental Health Nursing. https://doi.org/10.1891/9780826131294.0028

Lazar, S. (2019). Deontological Decision Theory and the Grounds of Subjective Permissibility. Oxford Studies in Normative Ethics Volume 9, 204-222. https://doi.org/10.1093/oso/9780198846253.003.0010

Lestari, Y., & Prastyawan, A. (2018). Leadership Style of Organizational Developers and Builders in Creating Democratic Leadership. Proceedings of the 1st International Conference on Social Sciences (ICSS 2018). https://doi.org/10.2991/icss-18.2018.73

Miller, D. E. (2014). Rule utilitarianism. The Cambridge Companion to Utilitarianism, 146-165. https://doi.org/10.1017/cco9781139096737.008