Over the recent years, there was an escalating emphasis on the need for nurses to develop assessment consultation and history taking skills for prescribing patients with drugs as well as to gain knowledge within sophisticated clinical practice roles. Specifically, nurses are qualified to learn and apply patient assessment and consultation skills in their nursing practice. These skills can form a corner stone of becoming a proficient, well-trained nurse.
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The present essay focuses on the assessment skills, principles of drug history taking process and Clinical Management plan reflecting on a specific case study where in which the nurse prescriber indicated an Allevyn adhesive dressing to manage the healing process of Leg Ulcer in a patient.
Within primary and community health care, the methodological and systematic assessment plays a major role and it is the crucial requirement of government policy. In the face of congregating dependence upon care management and public fund targeting, the role of assessment skills was increasingly becoming important policy tool (Charles et al., 1996).
Connecting to the present case study, the nurses must demonstrate and utilise all of his/her senses in assessing the patient. Typically, these involve listening (hearing), feeling (touching), observing (visual) and therapeutic communication processes (Wright, 2007). Generally, an approach pertaining to cephalocaudal type must be utilised by all nurses in assessing the patient from head to toe region. In performing an assessment with relation to Leg Ulcer (or any disease), it is very important for the nurse to possess basic requirements related to stethoscope, sphygmomanometer (to check the blood pressure), thermometer and penlight. The hospital and the instrumental setting are also important in carrying out an assessment. The nurse must indicate high observant skills and must strive hard in obtaining as much information as possible (about the Leg Ulcer disease) from the patient to effectively formulate the nursing diagnosis (Kimmel, 2005). Additionally, the nurses need to have the following skills:
This specific skill can enable the nurse to identify the similarity patterns of the events associated with the Leg Ulcer and linking them to the previous encounters visualised with other patients. Nurses must recognise the subtle changes within the personâ€™s health status, comprehend the potential consequences of the Ulceration and then act accordingly to specify the treatment (Wright, 2010).
This may help the nurse to engage within the process of holistic problem solving skills and to analyse the premonitions or intuitions. Particularly, this becomes significant in opening up the complexities associated with the disease (Kimmel 2005).
This feature develops from the fundamental sciences through which Nursing Sciences has been originated-physiology, sociology, pharmacology, ergonomics, medicine, philosophy. In addition, the knowledge gained through nursing practice, research and allied health professionals can also be included in this skill (Wright 2007).
Help in recognising formulating options and considerable changes persistent with the Leg Ulcer disease (Kimmel 2005).
These skills get developed with the interpersonal communication with patients and residents, their families and colleagues. Supporting, enhancing, facilitatory and counselling skills in relation to the progression of the Leg Ulcer disease are the other types of skills that are essentially needed in patient diagnosis (Wright 2010).
Lastly, the Standards of Care pertaining to diagnosis, outcome identification, planning and evaluation must be implemented to achieve a relatively higher level of wellness towards physical and emotional perspectives.
By imbibing the above skills, the nurse carried out the initial assessment process soon after meeting the patient. Subsequently, other follow up measurements must be implemented on a weekly basis with special attention oriented towards the following characteristics:
Signs of Infection
For the patient with identified Leg Ulcer, the signs of infection involve decreased blood pressure, tachycardia, fever (septic symptoms), pain, redness and warmth including swelling near the ulcerated tissue, purulent drainage from the diseased area (yellow and greenish fluid draining out from the portion) (Morgan, Thomas 2010).
Stage of Wound, Category and its Type
Wound Staging is an effective way to effectively categorise the Leg Ulcer or any form of Progressive Ulcer. This involves understanding the stage or degree of wound (ranging from I-IV and alleged deep seated tissue injuries). Additionally, it enables in classifying the wound type (Arterial or Venous) based on the partial or complete thickness of discharged fluid (Harding, Leaper 1998).
Is the dead (devitalised) tissue that is soft and moist and which is usually adherent to the base portion of the wound. This indicates the infection processes near the wound site (Kimmel 2005).
Detection of Eschar
It is the dried, firm and harder dead tissue covering the wound surface. Typically, it can be black, red or brown in colour depending upon the necrosis in wound progression and amount of blood presence. This form must not be confused with the slough and should be evaluated by the Nurse as a part of wound assessment (Harding, Leaper 1998; Morgan, Thomas 2010).
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