Implementing and Evaluating a Nursing Care Plan - Assignment Example

Implement & evaluate a plan of nursing care IMPLEMENT & EVALUATE A PLAN OF NURSING CARE Titus Rock Manickam Order No. 298918 15 May 2009 IMPLEMENT & EVALUATE A PLAN OF NURSING CARE Impaired mobility related to surgical procedure Plan The plan is to help patient move whenever required, particular when there is the need to wash, toilet needs, or changing clothes. The patient has been operated on for correction for fractured neck of femur. The operation has been successful. But the patient is aged 80 years. Advanced age slows the healing process. Also patient's BP at 170/95 is high. However, it was obviously under control when the surgery took place (Blood Pressure). Client Outcome Nothing is disclosed about the nature of the client except for her age, BP, pulse and temperature. Obviously, the patient will be quiet and drowsy as a result of the anesthetic effects for a day or two. The patient is dependent on nurses to carry out personal functions such as changing clothes, cleaning and toilet needs. Interventions The patient is left to recuperate and few visits by close relatives are allowed in the first few days. A nurse is close at hand to administer medicines and monitor BP and pulse rates, and for any other emergency needs. Evaluate The condition of the patient is stable. The surgery has been successful. Muscle strength reduces considerably during the first few days post-operation. Enteral feeding was resorted to as the patient is aged and relatively weak as a result of her advanced years (Watters, J.M. et al). Self care deficit bathing/hygiene Plan Self care is not possible due to the surgery. All cleaning and other hygiene based activities have to be carried out with the help of nurses. Self care deficit may also result due to inabilities related to muscular impairment, energy deficit, pain, anxiety, and decreased motivation (Nursing Diagnosis). Sufficient treatment must be made available to address any such deficit as mentioned above. Client Outcome The client is not in position to administer self-care. All post-operative care must be carried out by nurses. The patient is weak and immobile due to surgery. There is no way the patient can be expected to move or make attempts to move during the first few days post-operation. The nature of the surgery on the patient's femur which is central part of the functions of the human body makes it well nigh impossible for the patient to attempt movement during the first few days of the surgery. Interventions All activities connected to the patient's movement must be coordinated with the assistance of nurses. The patient is totally dependent on nurses to help with any movement activity because of the surgery and also because she is advanced in years. The patient may be gently coaxed to some movement involving her hands. The movement of hands and face will help provide some relief from the overall restrictions in mobility. Evaluate Constant follow up with the patient's temperature, BP, pulse rate, medication, and other organic symptoms such as functions of the heart, liver, intestines, etc. is necessary in order to ensure speedy recovery. The patient is not suffering from any disorder other than the surgery involving her femur. Her BP is, however, high and it is obvious that it was under control during surgery and is kept under control post-operation. Impaired Skin Integrity Plan Periodical cleaning of the skin with antiseptic is necessary to ensure patient is hygienically in good shape. Advanced age coupled with surgery raises the risk of skin impairment. There must be good plan in place to keep the immediate surroundings clean. The clothes and dressing of the patient must be changed are regular intervals. Client Outcome The treatment following the days after the surgery is critical to ensure fast recovery. The client is almost cent percent dependent on nurses to do all post-operative care including those required for prevention against skin breakdown. Change of bed sheet, pillow covers, etc. must be carried out on daily basis. Interventions Normally, doctors and nurses carry out all the necessary tasks to execute and monitor all activities for fast recovery of the patient. The routine of managing a clean environment around the patient is executed by the nurses. The patient has little to do except move hands and face to ward off boredom and weakness. Evaluate The patient is susceptible to skin disorders because of the surgery and lack of movement resulting due to the surgery. Advanced age can contribute to falling easy prey to skin disorders. Good hygiene and medication are necessary to keep patient's skin in proper shape during post-operation period. Potential for infection Plan Undoubtedly due care will be taken during surgery to avoid infection. All precautions such as avoiding overcrowding in the operation theatre, keeping the body warm, use of antibiotics if any, will have been taken to ensure that the patient is physically good condition to resist infection. There is also the need for post-surgery vigilance to stay clear of infection. Any unusual feeling of chillness and fever could arise due to infection (Schoen, Delores Christina). Client Outcome Once the effect of anesthesia has subsided, the patient will start feeling pain. Doctors will prescribe analgesics as desired to reduce pain. There is good chance that the patient will respond positively to analgesics in normal conditions. However, care must be taken so that the analgesics do not hide the symptoms of infection. Interventions The area of surgery must be the place to watch for signs of infection. Normally the wounds heal in the normal course in some days. Also, doctors take care that these spots where surgery has been carried out are sanitized against infection. Nonetheless, by way of abundant caution there must be vigilance against any sign of infection that could arise in spite of proper care. Evaluate The patient is normal except for the surgery. Also, her BP reads on the higher side. But the patient is not diabetic. There must not be undue fear of any infection taking place. But, of course, all due care must be taken to prevent any infection, and to handle it in case it shows sign of arising. Potential for social isolation Plan The patient is very aged. So the fear and possibility of isolation is present. The patient was found fallen by the next door neighbor. There is no mention if any family member is present. It is important to have some family members on the scene so that the aged patient does not feel uncared for. Client Outcome The client has accepted her condition as a normal mishap. There is no mention if she has complained of any feeling of isolation. However, there is the possibility that she is hiding her feelings. Hence, it is necessary to have caring family members present to show that someone is there to take care of the aged patient. Interventions The doctors have informed the police about the accident. Normally, the police carry out investigation and find the whereabouts of close relatives of the patient. There is the possibility that the police carried out such investigation and traced some family members who would come to the hospital to be with the patient and perform other familial duties in such critical condition. Evaluate It is difficult to make evaluation in the absence of any information about family members and friends. The patient was found in fallen condition by the next door neighbor. Hopefully, family members have been found and informed of the accident. Sources: Blood Pressure, A New Approach, http://community.middlebury.edu/harris/bloodpressure.html Nursing Diagnosis: Self-Care Deficit, Nursing Care Plans, http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfmplan=43 Schoen, Delores Christina, Adult orthopaedic nursing, http://books.google.co.in/booksid=hIq32ObcDZIC&pg=PA334&lpg=PA334&dq=Potential+for+infection+post-surgery&source=bl&ots=fNgiFQN5UE&sig=wYJu-A0nlPkgcTMBwWr09K3CB3o&hl=en&ei=_40NSrb1IdCSkAWCp-WYBA&sa=X&oi=book_result&ct=result&resnum=5 Watters, J.M. et al, Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility, http://www.pubmedcentral.nih.gov/articlerender.fcgiartid=1191041 Read More