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.

Okay, 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 blood pressure 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 Meena has just received shift report for three patients in the medical-surgical unit and is determining the order in which to address the care each patient needs. Nurse Meena gathers and reviews additional information about her three 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 2 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 percent on room air. The health care provider recently entered orders for him to be discharged. Next up is Deion, 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 Meena 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 Meena prioritizes the order in which to assess her patients based on the urgency of their acute and chronic needs.