Critical thinking scenario

Needs

Nursing intervention

Rationale

Desired outcome

Safety

• Maintain a neutral position of the hip that has been fractured.
• Usage of a trochanter roll.
• Put a pillow between the patient’s legs.
• Use a trapeze
• Supervision for usage of ambulatory aids.

• Helps to reduce and prevent stress where the site has been fixed.
• Helps in reducing external rotation.
• Helps in lending support to the patients legs and stops adduction from taking place.
• Helps in strengthening the muscles of the shoulders and arms that are imperative for ambulatory aid.
• Helps to prevent any injury from unsafe usage.

• The patient makes use of the positioning.
• Uses pillows positioned between the legs while turning sides.
• Makes use of the trapeze.
• Takes part in an exercise schedule.
• Makes use of ambulatory aids.

Hygiene and comfort

• Take care to keep the patient away from moisture as it is the breeding ground of infection.
• The patient should be cleaned daily.
• Sides of the patient should be turned frequently as well.
• The catheter tubes needs to be cleaned to prevent any infection.

• Helps in lowering the chances of occurrences of
• Pressure ulcers.
• Septic infections.
• Urinary tract infections.

The patient is healthy and free from any type of post operative infection.

Nutrition

• Monitor the intake of food and vitamins that are eaten by the patients.
• Follow a tailor made plan that keeps in mind the dietary requirements of the patient.
• It is essential to keep in mind that the patient is anorexic and can face malnutrition as a post operative complication (Jung, Trivedi, Grabowski & Mor, 2015).

In order to ensure the patient recovers fast and has optimum healing it is essential to consume minerals and vitamins along with a well balanced diet plan.

The patient is healthy, vitamin D levels are acceptable. Heals well and is in the final stages of recovery.

Elimination

• Monitor the intake and output.
• Avoid using a catheter.
• Perform intermittent catheterization for urinary retention.

• Having an adequate intake of fluids helps in marinating hydration and lowers the risk of having urinary stasis.
• Sources of a bladder infection.
• Helps in emptying the bladder and reduces the occurrence of Urinary tract infections as well.

• The intake and output should be plenty and the patient shows voiding patterns that are normal.
• There is no evidence of a urinary tract infection.

Activity levels

• Monitor the range of mobility of the patient.
• Response to commands

• Helps in gauging the range of defect in motion.
• Analyzing the neuromuscular functioning of the patient (Jung, Trivedi, Grabowski & Mor, 2015).

The patient should be alert and not in a delirium and is quick in responses (Burns et al., 2014).

Psychosocial needs

• Encourage the patient to express their fears and concerns while discussing the fracture (Resnick et al., 2016).
• Support them while using coping mechanisms.
• Contact social services if the need arises.
• Encourage the patient to take interest in the planning process,

• Expressing their thoughts and concerns lowers the anxiety and stress levels.
• Coping mechanisms help in reducing fear and stress.
• Anxiety can be due to stress of finances and other problems.
• Taking part in planning care activities gives a sense of control.

The patient demonstrates feels of concern for his injury and wants to help in the process of planning.

Medication

Indication for use

Nursing implication

Effect on patient

Digoxin 62.5 mcg OD

For patients suffering from ventricular rate control in patients with chronic atrial fibrillation.

• acute myocardial infarction
• Adams-Stokes syndrome
• AV block, bradycardia, cardiomyopathy, cor pulmonale, hyperthyroidism, hypothyroidism, hypoxemia, myocarditis, myxedema, pulmonary disease, sick sinus syndrome

The patient could suffer from an acute myocardial infarction ("Digoxin (digoxin) dose, indications, adverse effects, interactions... from PDR.net", 2017).

• Warfarin 2 mg OD
•  

• Prophylaxis and treatment of:
• Venous thrombosis,
• Pulmonary embolism,
• Atrial fibrillation with embolization.
• Management of myocardial infarction

• Severe liver or kidney disease;
• Uncontrolled hypertension;

• Decreases risk of death,
• Decreases risk of subsequent MI,
• Decreases risk of future thromboembolic events.
• Prevention of thrombus formation and embolization after prosthetic valve placement.

Coversyl 5 mg OD

• Heart failure
• Diabetic nephropathy

• Hypersensitivity to drug or other ACE inhibitors
• Hereditary or idiopathic angioedema

dizziness, fatigue, headache, insomnia, sleep disorder, weakness, asthenia, drowsiness, vertigo, depression, paresthesia

Vitamin D 1,000 units OD

Used for lack of vitamin D in the body

Bones become vulnerable to fractures.

Osteoporosis.

Metformin 500 mg BD

Diabetes and hypoglycemia.

Monitor for decreased liver function and a predispose to lactic acidosis.

risk of lactic acidosis

Esomeprazole 40 mg OD

GERD/erosive esophagitis

• Bone fracture
• Nausea
• hypertension

Hypersensitivity

• A. Efexor 150 mg OD
• B.Caltrate 600 mng OD
• C. Mylanta 15-30 mls prn

• Depression, generalized anxiety disorder; social anxiety disorder.
• Caltrate is used for preventing low calcium levels.
• Gas/ heartburn

• Hypersensitivity
• Can cause constipation
• Hard stools (constipation) and loose stools (diarrhea)

• Renal and hepatic impairment, renal failure; anorexia nervosa ("VENLAFAXINE", 2017)
• elevated intraocular pressure, acute closed-angle glaucoma ("Caltrate 600+D: Indications, Side Effects, Warnings - Drugs.com", 2017)
• cardiac disorders
• recent MI, heart failure; hypertension; hyperthyroidism; concomitant administration with CNS drugs, CNS depression; history of seizures or seizure disorders;

Risk

Intervention

Explanation

Pressure ulcer

Usage of polyurethane foam dressing.

Usage of a pressure relieving mattress.

Reduces the friction and shear that the wound area is subjected to. Helps in reducing the skin area from excessive exposure to moisture (Burns et al., 2014).

Constipation

• Emphasis on privacy and access to a toilet.
• Avoid long time period of fasting
• Encourage usage of fluids.
• Usage of laxatives.

Can cause problems in mobility if not monitored.

Risk of unresolved pain.

Usage of pain relievers. Start with paracetamol and go on to stronger drugs if needed opiods and nerve blocks.

Mobility

Nutritional Deficit

Reduce fasting period.

Intake of minerals and vitamins

Cause weakness and fatigue hence an optimum balance needs to be maintained.

Nursing intervention

Rationale

Outcomes

Provide encouragement to the patient to express her concerns about care at the rehab facility. At the same time be sure to explore various solutions for the patient’s problems.

The patient could have certain problems in movement after the surgery hence it is imperative to clearly identify the problems so that the appropriate solutions could be put to use.

• The rehab facility should be easily accessible to the patient when she is discharged.
• The patient should be less anxious and relatively calm. Should be able to devise strategies to deal with the problems.
• Personal assistance is available at all times.
• The patient complies with the medication and therapeutic regime that has been prescribed.

2.Check the availability of the assistance for various heath care related activities and assistance specifically for ADL’S

Due to the lowered rate of mobility because of the fracture the patient will need help in ADLs and during routine activities. So that the patient can go about doing their daily activities (Arnadottir, 2017).

Teach the patients’ assistances the specific health care regime that needs to be followed.

Having a complete understanding of the rehabilitative regiment is very essential for complete compliance.

• The patient should be advised upon post hospital care:
• The limitations while undergoing various activities.
• The exercise instructions should be reinforced.
• Safety while usage of ambulatory aids.
• Caring for the wound.
• Healing measures that comprise of nutrition and wound healing.
• Medications
• Problems that could arise.
• Health care supervision.

It is essential to have complete knowledge about the health care regime that needs to be followed while in rehab. As lack of knowledge could cause anxiety to the patient along with non adherence and compliance to the medication and therapeutic regime.