Critical thinking scenario

• Introduction
• Answer 1.
• Answer 2.
• Answer 3.
• Answer 4.
• Answer 5
• Answer 6.
• Conclusion
• References
  

Introduction

The case study that has been provided for the purpose of this research paper is about Mrs. Audrey Smith, a 75 year old woman who was brought to the Emergency department after she was found lying down on the kitchen floor by her neighbor. The patient had tripped over her dog and had been diagnosed with a fracture of the neck of the femur, soft tissue injuries, bruising to her left shoulder and a small hematoma on her left forehead. The GSW scale reading is 14. The patient’s past medical history is indicative of AF, hypertension, L-CVA, T2dm GORD, osteoporosis, hysterectomy in the year 1995 and has been suffering from depression since the year 2011. The paper will analyze and critically access the nursing interventions that are required for the patient’s safety, health and hygiene.  The patient is suffering from a fracture of the neck of the femur. It is a common injury that takes place in the elderly. Femoral neck fractures can either be extra capsular or intracapsular in nature. When the fracture is between the joint and the capsule it is known as an intracapsular fracture. These are very problematic as there is an interruption in the blood supply to the femoral head and can cause tissue necrosis. While the extra capsular fractures take place outside of the capsule. Here the blood supply is less compromised and operative fixation is mainly dependent upon the kind of fracture that has been caused.

Answer 1.

Answer 2.

The patient Mrs. Audrey has a past history of the following:

1. AF
2. Hypertension
3. L-CVA in the year 2008
4. T2DM in the year 2008
5. Osteoporosis
6. A total hysterectomy in the year 1995
7. Depression since the year 2011

The patient needs to undergo a surgery to fix her fracture. However one of the most imperative factors to take into consideration is the risk of developing a urinary tract infection as the patient is prone to them along with moderate constipation and development of pressure ulcers. The patient has a history of anorexia hence care needs to be maintained that the patient does not become nutrient deficient after the surgical procedure takes place as it could cause the hemoglobin levels to reduce further. Mrs. Audrey suffers from osteoporosis thus her femoral fracture outs her at a higher risk for having a future fragility fracture. Hence secondary prevention needs to be made on top priority. Bone strength needs to be maintained and the process of bone loss needs to be slowed own. Hence it is suggested that a complete serum and urine protein electrophoresis test is carried out along with lifestyle changes, cessation of alcohol consumption. The patient has been consuming Vitamin D 1000 mg per day to treat her deficiency along with a calcium substitute to treat her bone loss.  One of the major risks that the surgery can have on the patient is constipation and it can cause pressure to build up on the surgical site as the patient is already suffering from constipation and moderate urinary incontinence extra care and precaution needs to be maintained so that these factors do not turn into life threatening scenarios for the patient (Sheehan, Sobolev, Chudyk, Stephens & Guy, 2016). The patient is also on medication for the treatment of hypertension and has underdone treatment for AF and L-CVA in the year 2008 as well. The patients underlying conditions can create a negative impact for the post surgical care that needs to be provided to Mrs. Audrey.  Furthermore the patient has been a widow and is living alone with minimum interactions with members of the community and is thus suffering from depression. Healing post the surgery can be complicated if the patient is depressed, hence care needs to be taken that the patient is provided motivation so that she can become mobile soon.

Answer 3.

Answer 4.

Prior to the surgery as a nurse it is very essential to prepare the patient for the surgery that is to take place. The patient needs to be prepared psychologically as well as physiologically for the surgical procedure that is to take place during the preoperative phase. The nursing interventions that take place are aimed to treat and at the same minimize the medical conditions that preexist. It is imperative as a nursing professional to make certain that the patient is provided all the information and support pertaining to the surgical procedure that is to take place. It is essential that all the risks of the procedure are also discussed with the patient beforehand to lower down the anxiety levels.  Preoperative preparations comprise of various nursing activities that consist of the collection of data by conducting an assessment of the patient’s condition, providing emotional support, post operative care and having a clear flow of communication with the patient. Make use of the SBAR communication method while interacting with the patient. The following nursing interventions are suggested while treating Mrs. Audrey as she is very anxious and is constantly asking about the well being of her dog, as she is afraid nobody will be there to take care of him.

1. Attentive listening.
2. Provide all the necessary information pertaining to the procedure.
3. Solicitation of the patient’s anxiety.
4. Provide reassurance and emotional support at all times.
5. Administer an enema a night before the scheduled surgery as it helps in cleansing the colon.
6. The operative area of the skin should be prepared to free it from any microorganisms.
7. The patient should be helped to bath or shower to lower the risk of infection and to maintain hygiene. Also it could be days before the patient could be allowed to have a real bath.

Answer 5

The immediate nursing interventions that will be implemented when Audrey returns to the ward at 2000 hrs are as follows:

Post operative nursing considerations:

The patient could be at the risk of the following:

1. Alteration with respect to their ABC pathway, it comprises of hypertension and the patient has a past history of hypertension.
2. Urinary incontinence
3. Nausea
4. Neurovascular deficit
5. Risk of infection
6. Unable to maintain hygiene
7. Deep vein thrombosis or PE
8. Problems in gaining mobility
9. Further or fractures that could occur in the future as the patient suffers from osteoporosis
10. Development of pressure ulcers.
11. Constipation
12. Pain that is unresolved.
13. Nutritional deficit.

Also care needs to be taken that the patient is attended to at all times, pain medication is considered for pain management, usage of pressure relieving mattresses should be done so that pressure ulcers are not formed. The diet of the patient should be looked into so that the patient has optimum healing.

Answer 6.

10 days after the surgery, Mrs. Audrey Smith will be sent to a rehab facility however prior to this transition it is imperative to ensure that the patient can adjust and adapt to the new changes that will be taking place in the times to come. Mentioned below are 4 nursing interventions that will be implemented during this transition phase for Audrey.

Conclusion

The paper has analyzed the care that needs to be provided to Mrs. Audrey for a quick recovery. However nursing care is not just limited to surgery and the trauma that takes place it also addresses the deficits that are present in the patient’s health in the long run. Elderly patients are more prone to mal-nourishment and tend to have low hemoglobin. It is essential to monitor the dietary deficiencies so that proper wound healing can take place. Along with managing the strains that it causes to mobilization. The above mentioned interventions need to be followed for effective rehabilitation.

References

Arnadottir, S. (2017). OUTPATIENT PHYSICAL THERAPY IN ICELAND: ARE WE FACING THE POPULATION AGING?. Innovation In Aging, 1(suppl_1), 946-946. http://dx.doi.org/10.1093/geroni/igx004.3402

Burns, A., Younger, J., Morris, J., Baldwin, R., Tarrier, N., & Pendleton, N. et al. (2014). Outcomes Following Hip Fracture Surgery: A 2-Year Prospective Study. The American Journal Of Geriatric Psychiatry, 22(8), 838-844. http://dx.doi.org/10.1016/j.jagp.2013.01.047

Caltrate 600+D: Indications, Side Effects, Warnings - Drugs.com. (2017). Drugs.com. Retrieved 22 October 2017, from https://www.drugs.com/cdi/caltrate-600-d.html

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Jung, H., Trivedi, A., Grabowski, D., & Mor, V. (2015). Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients With Hip Fracture?. Physical Therapy, 96(1), 81-89. http://dx.doi.org/10.2522/ptj.20150090

Resnick, B., Beaupre, L., McGilton, K., Galik, E., Liu, W., & Neuman, M. et al. (2016). Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review. Journal Of The American Medical Directors Association, 17(3), 200-205. http://dx.doi.org/10.1016/j.jamda.2015.10.004

Sheehan, K., Sobolev, B., Chudyk, A., Stephens, T., & Guy, P. (2016). Patient and system factors of mortality after hip fracture: a scoping review. BMC Musculoskeletal Disorders, 17(1). http://dx.doi.org/10.1186/s12891-016-1018-7

VENLAFAXINE. (2017). Robholland.com. Retrieved 22 October 2017, from http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/V012.html