using avpu in ews

[ayla2004, ASN, RN]

i've a question from practice placement

on my last day with my mentor of a medical ward we had a pt going septic and the doctors were well aware and planing to step him up to mdhu or itu.

Avpu is part of out ews, this patient only seemed to have a response when he checked his blood glucose(for hourly sliding scale), he moved the hand away slightly no eye opening. I assesed this as a reaction to pain. he hadn't been diagnosed as diabetic very long so his finger tips were still pristine.

a pain response is a 2 and combined with other factors made him a ews=5

and then we tell a SpR (registar)

having had neuro experience i find avpu unclear GCS is more discreet

and he would have been 6-7

i have never had clear teaching of this tool, had an pt with know eplisey, and dementia 'go vacant' on me whilst i was giving her her medicines, had been handed over that she was been like this yesterday, wasn't responding to voice though normally would, applied sternal pressure to get response and checked obs a. when is used pain in these situations i've not got eyes open, anyone know any resources?

[nightmare, RN]

What does ' ews' mean?

[XB9S, BSN, MSN, EdD, RN, APN]

Early Warning score honey.

Ayla, AVPU is easy to use. It is the best assesment in an emergency and as with the GCS you use the best response gained.

For example, if you get to a patient and their eyes are closed but when you call them they open them and are able to stay awake then that is an Alert, if however they open thier eyes and are very drowsy or unable to stay awake then this a VOICE.

Is that what you meant?

http://en.wikipedia.org/wiki/AVPU

[ayla2004, ASN, RN]

so if the best response is the patient reacting to a painful stimlus like a needle even if it is limited, then i am right and that is a pain response and they are not unresponsive.

i did have a very good mentor but this may become a learning diary often in practice i react to the current needs and go on what i think is best running it by a staff nurse if possible.

the EWS was as i said run by the SpR.

EWS Early warning score design to monitor declining patient and improve outcome by promoting early interventions. it assigns a number to abnormal observations and ours include RR, HP, SBP, Temp, Urine output, and as a said AVPU. is a patient scores higher than 3 H.O/S.H.O get informed Greater than 5 is a SpR

obs chart include pain and nausea scoring. these are now even

coloured in discreet section green to red when charting each value.

[XB9S, BSN, MSN, EdD, RN, APN]

so if the best response is the patient reacting to a painful stimlus like a needle even if it is limited, then i am right and that is a pain response and they are not unresponsive.

that's exactly right Ayla

[ayla2004, ASN, RN]

that's exactly right Ayla

thanks sometimes i just check with others that what think/plan to do is what they would as well, which most mentor have agreed is normal and good practice in nursing.

[cariad]

so are the brits moving away from spelling things out and going down the american road of shortening everything with initials? i understood most of what you were saying but some initials in one particular place dont neccessarily match up with anothers. for example we have a pccu, a cvicu and ccu, we dont have hdu or scbu. but we do have pacu and nicu, oh and a tele floor,,,,,,,,see what i mean? i like the british way of spelling out everything so that mistakes are not made, there are so many acronyms and abreviations over here, that mistakes are made with them.

[LiverpoolJane]

yes it seems to be getting more confsing over here - everything is reduced to initials which has caused confusion - for instance i think of ccu as coronary care unit but otheres will writ it and mean critical care.

in my trust we have mdcu, hac, rac, gpau, apcu, wdu, fdu as well as the usual ccu, itu, mau and sau - i'm sure i'ver missed some out but these are the ones i juggle with daily.

at my trust we have the mews - modified, ews - very confusing!

so are the brits moving away from spelling things out and going down the american road of shortening everything with initials? i understood most of what you were saying but some initials in one particular place dont neccessarily match up with anothers. for example we have a pccu, a cvicu and ccu, we dont have hdu or scbu. but we do have pacu and nicu, oh and a tele floor,,,,,,,,see what i mean? i like the british way of spelling out everything so that mistakes are not made, there are so many acronyms and abreviations over here, that mistakes are made with them.

[RGN1]

We have Mews too - makes me think of cats personally! Most nurses don't use it properly anyway & I also find that it doesn't highlight things I think it should!

AVPU is easy though - if you're not awake & not verbally responding your in the "poo"(pu) & need further assessment! It's if you're in the "PU" that you then go on to look closer & use GCS etc. It's just a shortened, quick assessment to highlight if your patient is in real trouble or not.

For the interest of those who might not know here's how the acronym is broken down:

A - Alert - fully awake, though not necessarily orientated

V - Voice - patient makes some kind of verbal response

P - Pain - patient responds to painful stimulus

U - Unresponsive - unconcious

[nightmare, RN]

To be honest I'm completely lost with all these abbreviations!Things have moved on a good bit since my HDU days and reading Ayla's post was like a foreign language!

[ayla2004, ASN, RN]

i try not to abbreviate however it becomes so common from practie

each clinical area has its own set of them, and i end up picking them up.

when wtriting in patient notes we reored the ews score why it s raised and use abbreviations for whatever value heart rate hr etc.

our new obs form can be modified but the docs don't probaly as its the h.o. doing most of the work.

there are a number of extra abreviated units in my home trust most are the norm, itu, mhdu. shdu, nhdu, scbu, rhdu, etc

[cariad]

abbreviations are the way of it over here, but any american or non brit nurse reading your post would not have a clue what you are talking about. i even had to understand it and my command of the english language is good.