Management of Nursing Care: Assessment, Deterioration and Safe Practice
Assessment and recognition of deterioration
Every management question begins with systematic assessment: airway, breathing, circulation, disability, exposure, plus pain and blood glucose. Know adult reference ranges - respiratory rate 12–20/min, SpO2 95–100% on air, heart rate 60–100, temperature 36.1–37.2 degrees Celsius, urine output at least 0.5 mL/kg/hour - and know that respiratory rate and conscious state are the earliest and most frequently missed indicators. Apply the early warning score, escalate against the documented trigger thresholds, and call for help early rather than waiting for the next round.
Medicines and safety
Administration requires the right person, medicine, dose, route and time, plus the right reason and documentation. High-risk medicines - insulin, anticoagulants, opioids, potassium, cytotoxic agents - demand an independent second check and extra vigilance. Confirm two patient identifiers before any procedure or blood product. Use standard precautions for every consumer and aseptic technique for invasive procedures.
The traps
- Opioids: sedation precedes respiratory depression - a newly drowsy patient is a warning, not a chance to catch up on paperwork.
- Sepsis in older adults may present without fever, and a "normal" blood pressure may be abnormal for a hypertensive patient.
- Delirium is acute and fluctuating; dementia is chronic and progressive. Find the cause rather than sedating and moving on.
- Never bolus intravenous potassium, never crush a modified-release tablet, and never chart a missed dose as given - record it, tell the prescriber and state why.
Risk and documentation
Assess falls, pressure injury, nutrition, VTE and delirium risk on admission and whenever the condition changes. Document contemporaneously and objectively: what you saw, what you did, whom you told, and the response.
Rule of thumb
If the patient looks worse than the numbers suggest, treat the patient rather than the chart - escalate anyway.