MN 566 unit 3 assignment
Poor Patient Outcome
Clinical misdiagnosis because of late, inaccurate, and delayed diagnoses is a continuing problem in the United States. The diagnostic errors usually pose a serious ongoing risk to the safety of the patient and the health, and it also cost the nation billions of dollars (Hong, et al 2017). Effective treatment always depends on the effective and accurate diagnosis; misdiagnosis usually lead to unnecessary and inappropriate testing and treatment which cause harm and even patient death. Merely relying on or assuming features of a given condition most of the times mislead because even the presence of a disease usually varies such that the sign and symptoms of many diseases are nonspecific and hence need days, hours and even months to develop. This paper addresses a case scenario of a misdiagnosis involving a 35-year-old lawyer who records the complaint of a non-productive cough and chest pain. The client was observed for an hour in the office, and he was diagnosed with viral pleurisy and was hence allowed to go home on non-steroidal analgesics. In the end, an autopsy indicated a type 1 aortic categorization with pericardial tamponade after the patient collapsed at home and could not be resuscitated.
Pleurisy happens when once the double membrane is also known as pleura, which surrounds the lungs and lines the chest cavity becomes irritated. It usually causes sharp pain, especially during breathing. The pain is stabbing and strong when one takes a full breath. On the other hand, aortic dissection is a terrible but rare illness often associated with tearing chest pain as well as acute hemodynamic compromise. The two conditions show similar symptoms that seem to have contributed to the misdiagnosis (Paary, et al 2016). Coming up with a list of likely circumstances that may give a client symptoms and signs is a crucial part of the clinical reasoning because most mistakes in clinical reasoning are not caused by lack of knowledge or incompetence but are primarily caused by human thinking under conditions of uncertainty, complexity, and pressure of time. Therefore to minimize misdiagnosis, we first need to understand its cause and prevalence. The first approach to offering optimal care is ensuring a correct diagnosis which is missed in this case scenario.
The first thing I would do differently as an NP in primary care is to reflect on clinical reasoning skills. A nurse with comprehensive clinical reasoning skills always shows a positive impact regarding patient outcomes. With poor clinical reasoning abilities, a nurse usually fails to perceive impending client deterioration resulting in misdiagnosis and failure to rescue like in this scenario where the patient was unable to resuscitate even through paramedic service. The top reason for the client adverse outcome was the failure to accurately diagnosis, which contributed to the failure to institute essential and right treatment (Helfand, et al 2014). The two factors are associated with poor clinical reasoning, and that is why as an NP in primary care I would first consider clinical reasoning skills because they were missing in this case scenario. Clinical reasoning skills enable nurses to engage in active care for each patient in need of diagnosis or care. A nurse who is experienced or has useful clinical reasoning ability may enter a client room and observe essential data, make the conclusion about the client and begin right care process. Most important is learning how cues shape clinical decisions as well as the association between cues and findings.
Another thing I would do differently is not to trust the tests in the first place. For this scenario, patient information gave similar signs of two different diseases, and the nurse had to believe the first test. Some tests might be wrong most of the time because interpreting or evaluating such analysis like the one in this scenario was a matter of expertise and judgment. Many diseases look like another condition, and that is where clinical knowledge and experience are vital. It is not right to assume that a test is correct because it gives yes or no answer. In this scenario, I would have gotten a second opinion and not just an idea. It is helpful for another doctor to assess my case and conclusion other than thinking that the test results are final. As an NP in primary care, it is essential to recognize that one is not always right all the times and failing to admit it, reinforces doing things incorrectly (Fischer, et al 2017). It is critical to take a simple time-out to ask oneself whether the patient suffers from what the test indicates and whether one has reflected on everything that needs attention. It is not enough to rely on tests alone.
Another different thing I would do is to utilize a tool such as presentation checklists. Utilizing the checklists even when a diagnosis seems correct is one thing that most clinicians fail to do since the process seems just obvious. In most cases, there are frequent interruptions, and during such times there is the likelihood of forgetting to follow the important steps. It is important to write down every symptom that a client gives without forgetting any detail. It will help determine what condition to assess and the likelihood of a different condition showing up (Hong, et al 2017). Of most important also in this scenario is ensuring better patient-nurse relationship in my case. Patients with a good relationship with their doctor usually share a comprehensive history that helps reduce the occurrence of misdiagnosis that results from miscommunication.
After excluding all the possible possibilities, what must follow is finding out the truth before making up the final diagnosis decision. It is vital to reflect on different options of the medical problem concerning the client, following the available information in the differential list. The differential list offers the direction in which to order further investigations, for instance, the lab tests and imaging studies among others. It also enables the short listing of possible conditions through correlating different outcomes with physical examination and medical history after testing. It allows one to decide which test the client should further undergo depending on the differential list possibilities that the identified test need to be carried out. With a differential list, it is possible to rule out correct assumptions that guide further testing.
It also helps raise concern since primary caregivers are not always perfect and they can as well make a mistake, and in this case, the deferential list will help confirm whether the diagnosis is useful in one way or the other. In this scenario, the differential list could have changed the outcome in many ways by first informing the diagnosis process. The clinicians could have had a chance to assess the two conditions such as viral pleurisy and type 1 aortic dissection since they possess similar symptoms. It could have expanded the nurse clinical reasoning to consider all possible indicators and conditions associated with sharp pain during deep breathing. Without a differential list, the nurse could not think of another probable cause of acute pain and ended up doing a misdiagnosis.
Fischer, C. E., Qian, W., Schweizer, T. A., Ismail, Z., Smith, E. E., Millikin, C. P., & Munoz, D. G. (2017). Featured Article: Determining the impact of psychosis on rates of false-positive and false-negative diagnosis in Alzheimer’s disease. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 3385-392. doi:10.1016/j.trci.2017.06.001. Retrieved from; http://search.ebscohost.com.lib.kaplan.edu/login.aspx?direct=true&db=edselp&AN=S2352873717300392&site=eds-live
Hong, Y., Qiufen, L., Maisa, K., & Dianjie, L. (2017). Bibliometric analysis of tuberculosis pleurisy based on a web of science. Biomedical Research (0970-938X), 28(7), 3322-3327. Retrieved from; http://search.ebscohost.com.lib.kaplan.edu/login.aspx?direct=true&db=a9h&AN=123089900&site=eds-live.
Paary, T. T., Kalaiselvan, M. S., Renuka, M. K., & Arunkumar, A. S. (2016). Clinical profile and outcome of patients with severe sepsis treated in an intensive care unit in India. The Ceylon Medical Journal, 61(4), 181-184. doi:10.4038/cmj.v61i4.8386. Retrieved from; http://search.ebscohost.com.lib.kaplan.edu/login.aspx?direct=true&db=mdc&AN=28078833&site=eds-live.
R. F. Helfand, a., T. Chibi, a., R. Biellik, a., A. Shearley, a., & W. J. Bellini, a. (2014). Negative Impact of Clinical Misdiagnosis of Measles on Health Workers’ Confidence in Measles Vaccine. Epidemiology and Infection, (1), 7. Retrieved from; http://search.ebscohost.com.lib.kaplan.edu/login.aspx?direct=true&db=edsjsr&AN=edsjsr.3865836&site=eds-live.