In medical practice one is usually faced by many situations and left with several decisions to make. Decision making should be guided by medical knowledge, facts, and work experience and skills gained over time. Patients present different situations that require specific attention. The decision on the most appropriate type of assessment to use is determined by a number of factors. Patients visiting for the first time will probably require a comprehensive assessment while routine care patients need a focused assessment. Focused assessments are done after a comprehensive assessment has identified the patient’s potential problem. It can also be conducted after an abbreviated or an interval assessment has shown a change in status different from the previously assessment result or report. This paper seeks to shed more insight on the dynamics involved in selecting and carrying out a focused assessment.
Analysis of the test results indicates that the patient has metabolic alkalosis as is presented by the high PH at 7.5. The bicarbonate HCO3 is also high at 32 mEq/L, indicating that the condition is metabolic, and not respiratory. Other signs of the condition include compensatory hypoventilation, restlessness accompanied by lethargy, confusion, tremors, muscle cramps, tingling of fingers, and hypokalemia. The acid base imbalance could be as a result of severe vomiting, inability to keep liquids and food down, and the use of excessive antacids. In a complete assessment the process would involve collecting comprehensive data concerning the history of the patient first followed by a physical examination. It is only after identifying the specific problem that examination is then conducted.
Manning and Rayfield (2005) argues that metabolic alkalosis is a condition where the patient’s concentration of serum bicarbonate (HCO3) is high. This condition emanates from the loss of H+ or the gain of HCO3- from the body. For a normal person it should be present as alkalemia (pH >7.40). Metabolic alkalosis while acting as a compensatory agent cause alveolar hypoventilation, this is caused by the rise in carbon dioxide in the arterial. This helps to diminish the change of the pH that would arise. Metabolic alkalosis is detected when there is an increase in the level of bicarbonate concentration observed through a serum electrolyte measurement.
The condition is diagnosed through arterial blood and serum electrolytes measurements. In cases where the condition is not clear from the physical examination and the clinical history, then urine chloride ion-concentration is necessary. In addition, serum onion gap calculation is used to distinguish primary metabolic alkalosis from the metabolic compensation. Treatment of the condition depends on the patient’s volume levels and the underlying etiology (Baid, 2006).
The pharmacological intervention for the acid-base disturbance is corrected by first restoring the fluid balance. The patient requires Normal Saline since they have an IV. It is important to check the potassium levels and correct it by replacing the electrolyte orally or through IV (Manning and Rayfield 2005).
It is important to acquire as much information about a patient’s past health history as possible. Questions on health history will generate information on the patient’s hospitalizations, psychiatric illnesses, surgeries, accidents, and allergies. In addition, more information is acquired concerning childhood illnesses, immunizations and any chronic illnesses. This is important for the medical practitioners to ascertain the history and possible cause of the illness. For women, it is important to find out more about their menstrual cycle history as well as the number of pregnancies and births (Manning and Rayfield 2005).
Manning and Rayfield (2005) points out that the patient should be able to tell if it is their first time to experience the condition they have now, and if so what type of medical attention they sought. Some important questions to ask when assessing abdomen or gastrointestinal system should be based on change in appetite, difficulty swallowing, and abdominal pain. In addition, seek to know about any vomiting or nausea, hemorrhoids, and histories of abdominal problems.
A focused assessment is the process of appraising the status and complains of a patient through observation and data collection, objective and subjective, by a registered nurse. The process involves identifying findings, both normal and abnormal, and the anticipation of changes and potential changes in a patient’s health status (Altman, 2010). It is important to carry out focused and complete assessments for revisiting patients since they guide a more specific focused physical examination so that the ultimate treatment plan decided upon would be holistic, all-encompassing, and sufficiently informed to address the entire problem based on its historical perspectives.
Berman et al (2008), notes that the scope of a focused assessment is guided by the symptoms, health history and age of the patient being examined. In addition, the use of this method can also be guided by the practitioner’s knowledge of the patterns for the presented complain. Consequently, patients returning to the hospital for routine health care or those with urgent care needs only require a flexible focused examination. In summary, therefore a focused assessment is best suited for established cases especially ones concerning routine care visits. It addresses focused symptoms and concerns that are restricted to a certain body system. In addition, it examination methods used should be as precise to a concern or problem as possible (Altman, 2010).
According to Altman, (2010) complete health assessments starts with acquisition of a comprehensive health history and a physical examination. This is usually conducted in acute care settings during admission or when an outpatient comes to a clinic for the first time.
On the other hand, a focused assessment is normally performed after a complete assessment has identified what the potential problem could be. It can also be conducted after an abbreviated or an interval assessment has shown a change in status different from the previously assessment result or report. A focused assessment is crucial as it facilitates the asking of questions about symptoms, a basis for a focus physical examination (Altman, 2010)
In conclusion, a focused assessment is used in cases where a comprehensive assessment had been done. It can also be done for patients who are just visiting for a routine check-up. In the case of the 22 year woman, the condition is likely to be metabolic alkalosis. A complete assessment was, therefore necessary in her case so as to have more insight into her medical history as a basis for treatment. This complete assessment would be very helpful for the doctors in gaining substantially crucial knowledge regarding the historical course of her illness, any previous diagnosis, and drugs administered. It would also have guided a more specific focused physical examination so that the ultimate treatment plan decided upon would be holistic, all-encompassing, and sufficiently informed to address the entire problem based on its historical perspectives.
Altman, G.B. (2010). Fundamental and advanced nursing skills, (3rd ed.). Clifton Park, NY: Delmar.
Baid, H. (2006). The process of conducting a physical assessment: A nursing perspective.
Berman, A., Snyder, S., Kozier, B., & Erb, G. (2008). Kozier & Erb’s Fundamentals of nursing: Concepts,process, and practice, (8th ed.). Upper Saddle River, N.J.: Pearson Education, Inc
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Manning, L and Rayfield, S. (2005). Vitamins, Minerals and Electrolytes. In Pharmacology Made Insanely Easy (p. 314). Bossier City, LA: I CAN Publishing, Inc.