The Efficacy of the Interventions Implemented for the Patient - Essay Example

?Running head: Case management review Assessment Task 3: Case Management Review Assessment Task 3: Case Management Review Case This is the case of Ronald (assumed name), a 73 year old male patient, recently widowed, who recently suffered a bathroom slip which caused the fracture of his hips (right femoral neck). He subsequently underwent a partial hip arthroplasty to repair his hip damage and allow him to regain mobility. He is hypertensive and is taking medications to maintain his blood pressure. He also has gouty arthritis and is slightly overweight. 2. Pathological changes a. Limitations on his mobility. Despite the hip replacement procedure, the patient would still likely experience limited mobility. He would have difficulty moving from one place to another; he would have difficulty sitting up, sitting down, standing, walking, and carrying out his activities due to his physical limitations. He would also have difficulty in going to and from the bathroom; and he would likely need assistance in moving about the residential facility. He would also undergo painful rehabilitation exercises and physical changes in his life. b. Depression. Having been recently widowed after the death of his wife of more than 50 years, he is also being forced to face the fact that he would spend the twilight years of his life without his wife. With his recent mishap, he is also likely to feel despair from his condition and such depression and despair would likely affect the success (or lack thereof) of his rehabilitative process. Depression is a major setback during the rehabilitative and recovery process for any patient. Ronald manifests symptoms of giving up, and of not trying hard enough to help himself recover and to improve his physical condition. This depression is also attributed to his recent loss and his advancement in age. Many elderly patients have to deal with this condition as they are brought face to face with the possibility of dying, of not being able to contribute anything to society, of losing a partner, and of being alone. c. Gouty arthritis. His arthritis is a major limitation to his mobility. Before his fracture, there were already deformities seen in his joints due to his gouty arthritis. Inflammation of his joints attributed to his arthritis caused much pain and difficulty in walking and in moving about. After the fracture, his arthritis has slowed down his rehabilitation; it is impacting on his mobility, making it difficult to move about and to carry out the physical therapy and occupational therapy exercises. 3. Nursing care needs a. Patient/resident specific care needs: Total hip replacement The patient underwent partial hip replacement after his hips were fractured. It is a procedure meant to remove and replace the acetabulum or the femoral neck. This surgery is an inpatient procedure, therefore the proper preoperative care must be carried out in behalf of the patient. He must be informed that he needs to prepare for a 3 or 4 day hospital stay. After the surgery, the patient is immediately started with his physical therapy (Gilbey, et.al., 2003). This includes transfer training and walking. The nurse would assist the patient and the physical therapist in his transfers and in his walking (Hol, et.al., 2009). This initial training would include the use of a walker in these transfers. After such training, a transition to crutches or canes may be made. The nurse must assist the patient in the proper use of the crutches or canes (Hol, et.al., 2009). The nurse must also ensure that there are no physical barriers which would interfere with the patient’s use of these assistive walking devices. Regular exercises to strengthen muscles must be carried out with the patient; the nurse would help encourage the patient to carry out these exercises. Such methods help ensure that the patient would eventually and safely regain his mobility and independence (Gilbey, et.al., 2003). The nurse would also have to teach and work with the patient in order to perform his activities of daily living. These activities would help ensure that the patient would eventually be able to carry out his activities of daily living independent of any health personnel assistance. Such process would make Ronald feel better and feel less dependent on health workers. It would also give him more dignity as a human being; it would eventually make him less depressed about his condition and his activities (Hall, et.al., 2008). The nurse also needs to instruct the patient on the importance of having a healthy diet and of physical activity in his eventual recovery and rehabilitation (Bennell and Hinman, 2011). A diet of fruits and vegetables would give him essential vitamins and minerals for stronger bones and faster recovery; it would also add fibre to his diet and prevent constipation (Bennell and Hinman, 2011). Physical activity would help prevent bed sores; it would also speed up his recovery and strengthen his muscles; and it would also prevent constipation (Bennell and Hinman, 2011). 3. Three areas which are relevant to the client’s care include: prevention of depression; falls; and pain. Prevention of depression: Assessment The Beck Depression Inventory is the appropriate depression scale to use for the patient. This scale would evaluate the patient on different levels and duration when symptoms are felt. Symptoms like sadness, pessimism, past failure, loss of pleasure, guilty feelings, punishment feelings, self-dislike, self-criticalness, suicidal thoughts and wishes, crying, agitation, loss of interest, irritability, changes in appetite, indecisiveness, worthlessness, concentration difficulty, and tiredness and fatigue shall all be evaluated in terms of length and duration where they are felt or experienced by the patient (The Lifeworks Group, 2001). In evaluating the patient using this scale, he was found out to be moderately depressed. The measures implemented to address his depression involve the application of Cognitive Behavioural Therapy. This therapy is applicable for the patient because it helps him adjust his behaviour and his cognition to manage his depression. This treatment would likely last for 15 sessions with the therapists and clients setting goals for therapy and agreeing on the goals for such therapy (Mor and Haran, 2009). The initial phase of the treatment would be on relieving symptoms with the goal of re-engaging clients in their daily activities and encouraging them to resume such activities. The next phase would include the cognitive change. Clients identify their automatic thoughts and evaluate possible alternatives of thinking (Mor and Haran, 2009). The final phase would include maintenance of treatment and prevention of relapse. Clients are also encouraged to reevaluate their usual thoughts and attitudes in relation to their activities, and to change these to better attitudes. In evaluating the efficacy of the interventions applied for the patient, the levels of his depression would be assessed using the Beck Depression Inventory. This evaluation shall be done two weeks after the first counselling session, and every two weeks after. The client’s general demeanour in terms of involvement in different activities, including his activities of daily living would be evaluated. Falls Assessment The Falls Risk Assessment Tool (FRAT) can be used in order to evaluate the patient’s possible fall risk. The first part is on evaluating falls risk status which assesses the number of recent falls and the amount of medications being taken; the presence of any psychological issues like anxiety or depression; and the assessment of cognitive status (Department of Human Services, 2006). The second part is the risk factor checklist which includes issues on vision, mobility, transfers, behaviours which manifest agitation, disorientation, and observed unsafe use of equipment; issues in the activities of daily living including unsafe footwear and inappropriate clothing; issues in the environment (orientation to environment); issues on nutrition and on continence (Department of Human Services, 2006). Based on the scoring, this patient has a medium risk of falling. There are various interventions which may be applied to address the patient’s fall risk. One intervention would be on the placing of hand rails in the hall ways and in other areas of the facility (Injury Research Centre, 2003). Another intervention would be to teach the patient the safe ways of getting up, of walking, and of getting up and down stairs (Crossman and Brigden, 2005). A review of his medications can also be carried out in order to evaluate if some of them cause drowsiness and changes to such drowse-inducing medications can be made (Department of Human Services, 2005). The hallways for the facilities must be well-lit and free of obstructions (Boushon, et.al., 2008). Light switches for rooms must be easily accessible at the bedside of the patient in order to ensure easy and clear access to the bathrooms when necessary and at all hours. Call buttons must be made available to Ronald at his bedside (Boushon, et.al., 2008). In order to determine the efficacy of the interventions being carried out for the patient, an assessment of the number of falls encountered by the patient within a weekly period can be implemented. Higher incidents of falls indicate that interventions are not effective. Pain In order to assess the patient’s pain, the visual analogue scale can be used in order to assess the patient’s pain levels. The Visual Analogue Scale (VAS) asks the patient to rank the intensity of the pain he is feeling from 1-10, 1 meaning no pain and 10 meaning the most intense pain (Sutherland, 2001). In the case of this patient, he indicates that the pain he is feeling from his hips is at level 8 intensity. Aside from the administration of analgesia to relieve patient’s pain symptoms, independent nursing interventions may also be carried out by the nurse. These interventions are mostly non-pharmacological. One such intervention is the application of relaxation and guided imagery (Ayers, Baum, and McManus, 2007). This process helps to relieve the patient’s stress and to distract him from the pain he is feeling. Other forms of distraction may come in the form of listening to music, watching TV, reading a book, and similar activities (Lubkin and Larsen, 2006). These are designed to redirect the patient’s mind away from the pain that he is feeling. These distraction measures can be helpful tools in managing a patient’s pain because they are non-pharmacological, non-addictive, and they are cheap. Nevertheless, in instances when such distraction methods do not seem to work, it is important for the nurse to monitor the patient’s pain intensity (Higgins, Madjar, and Walton, 2003). When the intensity or duration of the pain seems to increase, the attending physician must be informed of the need to either increase the dose or the frequency of the pain relief intake. It is important to ensure immediate relief for the patient’s intolerable pain experience because such pain may cause stress and anxiety to the patient (Casey, et.al., 2008). Since the patient is already hypertensive, it would not serve his best interests to have to go through anxiety in addition to his other health issues. In order to evaluate the efficacy of the interventions implemented for the patient, a reassessment through the VAS can be carried out every four hours. Pain relieved completely or partially within said duration can indicate the efficacy of the interventions. Discharge plan The discharge plan for this patient would mostly involve instructions on how to safely carry out his daily activities (Prouty, et.al., 2008). It would also include instructions on how to move about—from getting up, to standing up, to walking, to sitting, and to carrying out his activities (Prouty, et.al., 2008). It would also include activities and exercises which he now has to do on his own on a regular basis. The discharge plan would also include health teachings in relation to healthy living – including diet and exercise (Dionyssiotis, et.al., 2008). It would also include reminding the patient of his weekly therapy sessions to manage his depression; it would include his regular visits from the physical therapist; and it would also include reminders on his next check-up with his attending physician (Halasyamani, et.al., 2006). Works Cited Ayers, S., Baum, A., & McManus, C. (2007). Cambridge handbook of psychology, health and medicine. New York: Cambridge University Press Bennell, K. & Hinman, R. (2011). A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Journal of Science and Medicine in Sport volume 14, pp. 4–9 Boushon B, Nielsen G, Quigley P, Rutherford P, Taylor J, Shannon D. (2008). Transforming Care at the Bedside How-to Guide: Reducing Patient Injuries from Falls. Cambridge, MA: Institute for Healthcare Improvement Casey, C., Greenberg, M., Nicassio, P. Harpin, E., & Hubbard, D. (2008). Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma factors. Pain, volume 34, pp. 69–79 Crossman, T. & Brigden, R. (2005). The self-expression, gentle exercise and music (SEGEM) group: a multi-disciplinary exercise program. 7th National Rural Health Conference. Retrieved 14 April 2011 from http://nrha.ruralhealth.org.au/conferences/docs/7thNRHC/Papers/general%20papers/crossman_brigden.pdf Department of Human Services. (2005). Falls Risk Assessment Tool (FRAT). Retrieved 16 April 2011 from https://www.health.vic.gov.au/agedcare/maintaining/falls/downloads/ph_frat.pdf Department of Human Services (2005). Falls related medication side effects. 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Higgins, I., Madjar, I., & Walton, J. (2003). Chronic pain in elderly nursing home residents: the need for nursing leadership. Journal of Nursing Management, volume 12(3), pp. 167–173 Hol, A. van Grinsven, S., & Lucas, C. (2010). Hip Partial versus unrestricted weight bearing after an uncemented femoral stem in total hip arthroplasty: recommendation of a concise rehabilitation protocol from a systematic review of the literature, Arch Orthop Trauma Surg, volume 130: pp. 547–555 Injury Research Centre (2003). Injury in Western Australia: The Health System Costs of Falls in Older Adults in Western. Department of Health, Government of Western Australia. Retrieved 16 April 2011 from http://www.health.wa.gov.au/docreg/Education/Prevention/Injury_Prevention/HP1695_injury_WA_health_system_costs_of_falls.pdf Lubkin, I. & Larsen, P. (2006). Chronic illness: impact and interventions. New South Wales: Jones & Bartlett Mor, N. & Haran, D. (2009). Cognitive-Behavioral Therapy for Depression. Isr J Psychiatry Relat Sci, volume 46(4), pp. 269–273 Prouty, A., Cooper, M., Thomas, P., Christensen, J., Strong, C., Bowie, L., & Oermann, M. (2006). Multidisciplinary Patient Education for Total Joint Replacement Surgery Patients. Orthopaedic Nursing, volume 25(4), pp. 257 – 261 Sharp, L., & Lipsky, M. (2002). Screening for Depression Across the Lifespan: A Review of Measures for Use in Primary Care Settings. Am Fam Physician, volume 66(6): pp. 1001-1009. Sutherland, C. (2001). BMSA Treatment for Pain Management: A Preliminary Report on the Efficacy of Self-treatment with or without pharmacotherapy. The Lifeworks Group. Retrieved 16 April 2011 from http://www.lifeworks-group.com.au/pdf/BMSA_Chronic_Pain_Trial.pdf The Lifeworks Group. (2006). BMSA Treatment for depression: A Preliminary report on a group treatment program. Retrieved 16 April 2011 from http://www.lifeworks-group.com.au/pdf/BMSA_Depression_Trial.pdf Read More