Total Patient Assessment & Documentation Exercise

Total Patient Assessment & Documentation Exercise Order Description In ambulance and other areas of health care there is a sayin" rel="nofollow">ing “if it is not written down, it hasn’t been done”. This is very relevant to patient assessment. While most Western ambulance services now use detailed electronic patient report forms which prompt paramedics to acknowledge holistic patient concerns and relevant body system assessments, several services still rely on the paramedic to design and report on fin" rel="nofollow">indin" rel="nofollow">ings unprompted. The aim of this fin" rel="nofollow">inal assignment is to demonstrate a holistic range of assessment practices (which we have covered in" rel="nofollow">in this topic) that you may be called upon to use and report on, within" rel="nofollow">in the pre-hospital settin" rel="nofollow">ing. EXERCISE: 1. Fin" rel="nofollow">ind a person to volunteer to be a patient for you (friend, family member etc). 2. Please complete and report on a holistic assessment of this person 3. You may assume that your patient has presented with a “Conscious Collapse”. The rest of the in" rel="nofollow">information presented can be a blend of your own creative licences & actual fin" rel="nofollow">indin" rel="nofollow">ings from your chosen patient 4. Please report on all fin" rel="nofollow">indin" rel="nofollow">ings, both positive and negative as a way of evidencin" rel="nofollow">ing that the assessment has been completed/considered 5. Your completed document should resemble an extremely comprehensive/ extensive case card 6. You are required to report on any assessment which would be available to a paramedic. Please create your own fin" rel="nofollow">indin" rel="nofollow">ings where you do not have access to the required equipment (eg. ECG, BP, BGL) 7. You are not required to treat your patient 8. Dot poin" rel="nofollow">int / concise reportin" rel="nofollow">ing is suitable for this assessment 9. You are not required to explain" rel="nofollow">in your assessments. # Please do not attempt to complete this on an actual SAAS case card as you will not have enough space for the in" rel="nofollow">information expected to satisfy this assignment requirements. There is an approximate 2 page word limit for this assignment and no references are required. # please note ISBAR is not a recommended documentation tool . It may be useful to first identify a provisional diagnosis Somethin" rel="nofollow">ing that is fittin" rel="nofollow">ing with the conscious collapse, which will be the same presentin" rel="nofollow">ing complain" rel="nofollow">int for everyone eg. Orthostatic Hypotension. 2 Next you have creative license to create a fittin" rel="nofollow">ing history surroundin" rel="nofollow">ing the collapse. 3. Methodically and very thoroughly assess your patient - you may consider addin" rel="nofollow">ing fin" rel="nofollow">indin" rel="nofollow">ings which are consistent with your provisional diagnosis (eg. variance in" rel="nofollow">in lyin" rel="nofollow">ing/standin" rel="nofollow">ing BP in" rel="nofollow">in case of orthostatic hypotension), while in" rel="nofollow">includin" rel="nofollow">ing negative fin" rel="nofollow">indin" rel="nofollow">ings makin" rel="nofollow">ing other red flags less likely (eg. nil facial droop & CVA). 4. You may wish to review all of the recorded presentations to ensure all these assessment prin" rel="nofollow">inciples are covered off where relevant.