Acute and chronic: Clinical decision making

Distinguishing between acute and chronic conditions can guide nurses when prioritizing patient care. Acute conditions appear suddenly, have intense symptoms, and tend to resolve relatively quickly with treatment.

In contrast, chronic conditions have a slow onset, can worsen gradually over time, last more than 6 months, and can impair the functioning of multiple body systems.

Using an acute versus chronic framework allows nurses to successfully navigate patient needs within various clinical scenarios, and is essential for providing safe, quality care and improving patient outcomes.

OK, so acute conditions vary widely in type and severity, and include illnesses like urinary tract infections or UTIs, fractured bones, acute kidney injury, and appendicitis.

Acute conditions typically require immediate or urgent care to treat illness and prevent complications. For example, a patient with appendicitis will need surgery to remove the infected appendix, followed by care to promote healing, and prevent complications such as a surgical infection.

On the other hand, chronic conditions include illnesses like asthma, diabetes, hypertension, and autoimmune disorders, which require ongoing care and monitoring.

For instance, a patient with hypertension should have regular BP checks and medication management. Like acute conditions, managing chronic conditions also involves preventing complications, such as ensuring patients with diabetes receive regular foot care.

Now, let's look at a scenario where a nurse uses an acute versus chronic framework to make decisions and prioritize care.

Nurse Mina has just received shift report for 3 patients in the medical surgical unit, and is determining the order in which to address the care each patient needs.

Nurse Mina gathers and reviews additional information about her 3 assigned patients from the electronic health record, or EHR.

She starts with Roberto, a patient with a history of asthma, who was admitted for pneumonia two days ago. Following treatment with antibiotics and bronchodilators, he's since been weaned off supplemental oxygen, and has maintained an oxygen saturation at or above 95% on room air.

The healthcare provider recently entered orders for him to be discharged. Next up is Dion, a patient who underwent an emergency appendectomy last night, and was transferred from the post-anesthesia care unit to the medical surgical unit in the early morning.

Over the last 3 hours, his urine output has been steadily decreasing, despite having continuous IV fluids running. Then there's Sandra, a patient who underwent a liver biopsy yesterday afternoon for staging of her chronic liver disease.

Nurse Mina notes that the nurse on the night shift documented that Sandra had a small amount of blood on her abdominal dressing, and there was some blood oozing from her IV site.

Next, nurse Mina prioritizes the order in which to assess her patients based on the urgency of their acute and chronic needs.

She identifies Sandra as having the highest priority, due to acute bleeding from her biopsy site and IV. Even though Sandra's liver disease is chronic, nurse Mina knows that the liver is responsible for producing clotting factors, so this condition can increase the risk of serious bleeding problems.

Next, nurse Mina considers Dion, whose acute decrease in urine output could be due to the effects of anesthesia, which can promote urine retention post-operatively, or it could be a sign of decreased kidney profusion, potentially brought about by blood loss from the surgery.

Given these factors, nurse Mina determines he should be assessed after Sandra. Finally, she determines Roberto is the lowest priority, and can be seen last, since his acute pneumonia is being treated, his chronic asthma is managed, and he is ready to be discharged.

Based on this information, nurse Mina creates a plan to deliver care to her patients. While assessing Sandra, she plans on calling the rapid response team if assessment findings reveal additional signs of hemorrhage, like dizziness, increased bleeding, and bleeding from other sites.

While assessing Sandra, she'll ask the unlicensed assistive personnel, or UAP to check Dion's indwelling urinary catheter for issues that could impair draining, like kinked tubing, and measure the urine in the collection bag.

Nurse Mina will use the information gathered from the UAP regarding Dion to decide her next steps. Once Dion's needs are addressed, she'll plan to provide routine care to Roberto and review his discharge instructions.

Then, nurse Mina follows through with her plan. When nurse Mina assesses Sandra, she notices active, bright red bleeding from her biopsy dressing and IV site.

Sandra reports feeling dizzy, and states she feels pain in her abdomen, which could be a sign of internal bleeding. Nurse Mina calls the rapid response team, which quickly provides immediate treatment and transfers Sandra to the intensive care unit.

In the meantime, nurse Mina learns from the UAP that Dion's indwelling catheter is patent, and draining properly, but he's only voided 20 mL of dark yellow urine in the last hour, indicating poor kidney perfusion.

After assessing Dion herself, nurse Mina reports her findings to the healthcare provider, who orders serum laboratory work to gauge Dion's renal function.

Finally, nurse Mina enters Roberto's room to assess him, provide routine care, and start the discharge process. All right, as a quick recap, clinical decision-making involves distinguishing between acute and chronic conditions.

Acute conditions appear suddenly, have intense symptoms, and tend to resolve relatively quickly with treatment. In contrast, chronic conditions have a slow onset, can worsen gradually over time, last more than 6 months, and can impair the functioning of multiple body systems.

By integrating the acute versus chronic framework into clinical decision-making, nurses can promote quality patient care and improve health outcomes.