Acute deterioration in adults: pathophysiology of common signs and symptoms

Early recognition and management of acute deterioration is essential to reduce the risk of patients experiencing catastrophic events, such as cardiac arrest, and to prevent potentially avoidable deaths. Common signs and symptoms of acute deterioration include increased respiratory rate, alteration in skin temperature, increased heart rate, hypotension, reduced urine output and acute onset confusion. Nurses undertake clinical monitoring and observation of patients in acute care settings and are therefore ideally placed to recognise and act on these signs and symptoms. This article explores the pathophysiology of common signs and symptoms of acute deterioration in relation to body systems, aligned with the airway, breathing, circulation, disability and exposure (ABCDE) approach and with reference to the National Early Warning Score (NEWS) 2 'track and trigger' tool. The author also considers the contribution of clinical intuition, clinical judgement and effective communication in the management of the deteriorating patient.