The airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is the most recognized used for patient assessment. According to Peate and Brent (2021), the approach allows physicians to visualize a patient’s clinical problem, determine which intervention is most appropriate for the patient, and begin to plan an intervention. According to Peate and Brent (2021), the ABCDE approach is usually used in a step-wise fashion where the physicians start with the airway (by assessing airway patency and adequacy), then breathing (assessing breathing effort and respiratory rate), then circulation (assessing peripheral pulse, capillary refill time, skin color, and corneal reflexes). The first step is designed to help physicians identify potential problems in areas most likely affected by that specific condition; additionally, it helps them decide on their next treatment step.
Based on the case scenario, Amjad demonstrates signs and symptoms of acute onset gastroenteritis. These are indications of shock and dehydration, which will affect circulation due to hypovolemia (reduced volume within the circulatory system). In this case, Amjad is a deteriorating patient; therefore, the ABCDE assessment will include treating the patient with fluid resuscitation. The physician will be able to administer the right amount of fluid, including intravenous and oral fluids, and monitor Amjad’s oxygen saturation. The ABCDE approach would then assess the patient’s condition once they have received adequate fluid, including assessing his vital signs (heart rate, respiratory rate, and blood pressure) and monitoring his urine output (Linder et al., 2020). Amjad’s oxygen saturation is satisfactory, but his blood pressure drops, which may indicate his hypotension. Thus, Amjad’s condition is deteriorating rapidly and requires urgent therapeutic intervention.
Based on the assessment data, the relation to the underlying pathophysiology is that Amjad’s gastroenteritis is the cause of his shock, hypotension, and dehydration. Amjad’s gastroenteritis may have occurred due to not drinking enough fluids or food poisoning, for instance, from staying out in cold weather. Also, all these signs may mean that Amjad suffers from food poisoning because he did not eat any meat or fish in the past 24 hours. Amjad’s gastroenteritis may be due to some underlying condition. For example, Amjad may have sepsis. An important aspect of assessing a patient with symptoms related to their gastrointestinal system is to consider whether their symptoms are due to gastroenteritis or if they are the result of some other condition (Sunkara et al., 2019). Gastroenteritis is an infection affecting the gastrointestinal system, which frequently affects people worldwide (Bányai et al., 2018). Viruses, bacteria, and food poisoning can cause gastroenteritis. The main symptoms are nausea, vomiting, and diarrhea (passing watery stools containing mucus), which usually start within 24 hours. The symptoms usually last between 1 and 2 days.
In addition, based on the assessed data, the relation to the underlying pathophysiology is that Amjad might have sepsis It is because sepsis may cause Amjad ‘s body to have a chain reaction to the infection. This is because infections that that lead to sepsis starts in the urinary tract, which may results in the damage of multiple organ syatems, leading to their failure and ulyimately their death. As a result, Amjad may have an acute underlying illness causing his symptoms. Additionally, based on the above assessment data and underlying pathophysiology, the ABCDE approach suggests that the main referral areas include nursing. Amjad needs nursing care. Nurses may need to review Amjad’s fluid intake, insert a nasogastric tube and provide symptomatic treatment. Amjad needs resuscitation through the ABCDE approach care to be administered. First, nurses will ensure the airway, measure, monitor Amjad’s breathing if there are any concerns about circulation, and check his heart rate and blood pressure regularly. Also, it is important to ensure that all care is discussed with Amjad and that he is kept warm, and Amjad should also care for the environment and resources. In addition, based on the assessment data, Amjad shows symptoms of kidney failure, which is a chronic kidney disease. It is because, according to the assessed data, Amjad is a 57-year-old man who reported dysuria and frequent urination. He had not passed urine for the past 24 hours, hence acute kidney failure.
Using the ABCDE approach to discuss the assessment data shows that Amjad has an acute medical illness associated with a very change in his vital signs and symptoms. Peran et al. (2020) believe the ABCDE approach is useful because it allows the physician to assess the patient and their condition quickly. The ABCDE assessment provides physicians with the health knowledge necessary to make appropriate decisions to initiate and treat patients. A physician will then perform chest X-rays to look for pneumonia or other complications of dehydration, such as renal failure. A physician will also perform blood tests to check heart function. In addition, the relation between the assessed data and the underlying pathophysiology is that Amjad has gastroenteritis. His fluid input will be assessed by noting the information from the fluid chart, which may include urine output and gastric content.
The appropriate immediate intervention using an ABCDE approach includes Isolation, whereby the patient is isolated from possible sources of infection. In this scenario, a physician will escort the patient to a single room. Amjad is a potentially infectious patient and must be isolated until he is no longer a risk to others or no longer has the potential to be infected by other people. It is because fever, chills, and cough are all infectious symptoms that can spread to other people (Taherkhani, 2018). A physician will test Amjad’s temperature, examine his pulse rate and heart sounds, and look for a dry mouth, skin pallor, and the presence of any wounds. Particular attention will be given to his fluid intake and output, given that he has a history of vomiting and diarrhea.
Another intervention is resuscitation often involves simple procedures such as the placement of saline drips and oxygen therapy in case of difficulty breathing. A nurse or doctor must assess the patient’s airway; breathing rate; the color of skin and mucous membranes while assessing the need for oxygen therapy and intravenous fluid therapy, which may be required if there is shock (Abrams et al., 2021). In this case scenario, a nurse will assist Amjad with getting a bedpan, and a physician will assess Amjad’s condition; pulse rate, blood pressure, respiratory rate, and oxygen saturation. The nurse then prepares the bedpan and tests the patient’s urine for volume, color, smell, and clarity.
The other appropriate intervention is airway maintenance. This approach includes ensuring that patients are not hyperventilating, assessing their level of consciousness, and ensuring adequate oxygenation (Kogawa, 2019). It ensures that a patient’s airway remains patent and oxygenation supported, even if they vomit (Kogawa, 2019). In this case scenario, Amjad vomits during the initial assessment and has his airway protected by suctioning his oropharynx with an oropharyngeal airway until his airway is secured by an anesthetist who regulates his oxygen delivery via facemask. This intervention will help with the anatomical and physiological damage to Amjad’s airway.
The other intervention is circulation which includes monitoring the blood pressure and pulse rate, checking for possible signs of shock, and deciding on further resuscitative measures if necessary. In this scenario, the nurses will ensure that Amjad’s airway is patent, breathing is adequate, and there are no difficulties with circulation. It is because Amjad presents with signs of dehydration and is very dizzy. It is a good indication to consider emergency transport of a patient to the emergency department (Van de Voorde et al., 2021). On arrival in the emergency department, the emergency physician will assess Amjad’s poly-pharmacy. As Amjad has been taking multiple medications, the emergency physician must ensure that any trials relating to possible side effects or interactions are managed immediately. Suppose he is already experiencing any level of discomfort from his medications. In that case, an alternative arrangement will need to be made, such as hospital admission for more intensive monitoring and treatment if necessary.
Amjad has a history of hypertension, which makes him more susceptible to complications such as shock, heart failure, and acute renal failure. Monitoring his vital signs will include taking his blood pressure, which should be taken at least every four hours or more frequently when indicated by the patient’s condition, for instance, tachycardia or hypotension. It will help in the early detection of shock, acute renal failure, and heart failure (Kober et al., 2022). The nurse will also ensure that he is not left alone if he loses consciousness. Urinating an average of less than thirty milliliters per hour may indicate oliguria or anuria. The final intervention is that the nurse will ensure that the environment is safe and secure, the equipment is working correctly and stored away properly after use, and the nurse will also ensure that all drugs are labeled correctly and administered safely. The nurse will also monitor Amjad’s fluid output hourly, keeping in mind that the amount of fluid loss through vomiting, diarrhea, and insensible losses may be high and can rapidly lead to hypovolaemia. If a substantial amount of fluid is lost through vomiting or diarrhea, then the nurse may need to consider ways to replace the volume, such as intravenous fluids.
The additional data that could aid the assessment process is his tremors and twitching. According to Napoli et al. (2019), the tremors, dry mouth, dehydration, and twitching indicate that the patient has tremor-ataxia syndrome (TAS). It indicates that Amjad has metabolic acidosis. Amjad requires further investigation to determine the cause of the acidosis. The likely cause of the acidosis is a urinary tract infection; therefore, Amjad should be investigated for the possibility of UTI, and he should receive an antibiotic to treat the UTI.
In addition, Amjad should have arterial blood gases carried out to assess his acid-base status. It is impossible to determine the anion gap from a patient’s blood (McDonald et al., 2021). Abdominal examination shows mild tenderness but no rigidity or masses and no rebound tenderness (McDonald et al., 2021). Based on the assessment, no masses were palpable on the rest of the physical exam, and urine output was positive. The additional monitoring that could aid the assessment process is that Amjad has a thorough investigation to determine the cause of his acidosis and other complications. For Amjad to be best cared for, this investigation must be done rapidly because of his acid-base status, which affects how well he will respond to treatment. Thus, the underlying pathophysiology is that Amjad is at risk of developing diabetes. Amjad must undergo the additional investigations earlier rather than later as they will provide a better quality of care in terms of helping to make better decisions on managing the patient’s care.
The appropriate escalation of care using the Situation, Background, Assessment, and Recommendation(SBAR) communication tool is as follows:
- Situation: in this case scenario, Amjad presented to the emergency department at 3:00 pm with persistent symptoms of diarrhea and vomiting. It means that he is at risk of developing dehydration.
- Background: Amjad is a 57-year-old primary school teacher. He presents with gastroenteritis that has led to dehydration and signs of deteriorating health. He has a past medical history of hypertension and chronic kidney disease, which may increase his risk for renal failure if he is not managed appropriately. Furthermore, his penicillin allergy requires that another antibiotic be used in its place if he is prescribed one.
- Assessment: Amjad’s vital signs on admission are a temperature of 38oC, pulse rate of 132 bpm, blood pressure of 84/48 mmHg, respiratory rate of 26 breaths per minute, and oxygen saturation was 93%. Based on the above findings, Amjad has moderate dehydration due to gastroenteritis with complications, and he is, therefore, likely to require electrolyte replacement. He has a low-grade fever, and his vital signs must be closely monitored. In line with the SBAR message that should be conveyed to Amjad after taking his vitals and assessing his medical conditions is a plea for urgent medical assessment.
- Recommendation: To meet the potential complications of dehydration, Amjad needs immediate fluid replacement through intravenous fluids until he does not require them any longer. He also needs continued monitoring of his vital signs, including blood pressure, until stabilized for at least 24 hours after he appears adequately hydrated.
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