Care Planning Adult Patients with Complex Needs - Assignment Example

Care Planning Adult Patient with Complex Needs Table of Contents Part Care Plan 3 4 Part 2 5 Introduction 5 Airway Management 6 Rationale for Choosing Airway Management as the Top Priority for Mrs. Violet 6 Importance of Maintaining a Good Airway Post-Operatively 7 Possible Complications That Might Occur For Mrs. Violet 7 The Importance of ABCDE Assessment When Doing Vital Sign Observations after the Surgery, and the Need to Have an Accurate Assessment 7 The Interventions Available For Mrs. Violet to Make Her Feel More Comfortable 8 Possible Outcome/ Goal 9 Post-Operative Pain Management 9 Rationale for Choosing Pain Management as the Second Priority 9 Why Do You Think Violet Needs a Good Pain Management Post Operatively 9 Complications When Pain Management is Poor Post-Operatively 10 Interventions available in Post-Operative Pain Management 10 Prescribed Pain Management Medications Prescribed For Mrs. Violet in the Scenario 11 The Importance of Pain Assessment Using a Structured Approach and How It Will Help Manage Patient’s Pain 11 Possible Outcome / Goal 11 Chest Drain Management 12 Rationale for choosing this (relate to the scenario as her surgical site is currently oozing and there is small of blood in the drain bottle) 12 Outline Some Possible Complications That She Have or Will Have with This Kind of Procedure and the Effect to the Patient 12 What Are the Interventions and How Will You Avoid These from Happening and How Will You Assess the Patient 12 Why is it Important to Look after and Manage the Surgical Site Appropriately 13 Possible Outcome (Goal) 13 The Ways to Support Mrs. Violet’s Family 13 Conclusions 14 References 16 Part 1: Care Plan Problem/Need Intervention and rationale Goal – what do you want to achieve or happen for the patient? Recheck/evaluate when how? Priority Airway management Airway management is identified as an important procedure for managing airway between lung of patient and outside world. This management is important for exchange the air to reduce breath problem. In this respect, airway management would facilitate in improving respiration. The goal achieved through airway management is to minimize breath problem in the patient. Additionally, the patient can achieve effective support in terms of ventilation for breathing. She will be rechecked after the finish of her prescribed medicine. Here she will be checked through the various effective techniques of airway management that include Oropharyngeal among other for better revival of her health condition for the better treatment and recovery. High Priority Post-operative Pain management Post-operative pain management is an effective management, which helps the patient to have a relief from the pain as soon as possible. In addition, intervention that includes pre-operative pain assessment and pre-emptive analgesia among others will be used. This type of management also reduces the healthcare cost through early release from the hospital. In this respect, this type of care need will assist the patient in recovering her pain. The goal or objective achieved through this management is to provide quick response for the recovery of health. Patient can achieve low cost budget for the health treatment through this management. In this case, she will be checked again after completion of medication through effective method of pain management to know the status of her disease and infection through regular check on the site. The method of this management helps her for the better opportunities to recover soon. Medium Priority Chest drain site or management Chest drain management is an important key for the recovery and improved quality of the life of patients. This type of management helps the patients to permit the draining of air as well as blood through the chest tube. It also improves the healthcare of the adult patients. In this context, this type of management will aid the patient to improved drainage. The goal of chest drain management is to drain blood and air. The patient can achieve a good and appropriate drainage system. Additionally, the patient has a better relieve from pain. The method is effective in expansion of lungs and haemodynamic stability. The patient will be checked after some days to know that there is any infection or not and the site of draining of air as well as blood is infection free. In this respect, appropriate medication should be prescribed for better flow of blood and aid in the lungs. Low Priority Part 2 Introduction The essay intends to explain the concept of the care planning and its importance in nursing for the complex needs of the patients. Additionally, description of advance care planning provided to the patients for their complex diseases has been elaborated. Care planning is defined as the process of planning for medical care needed in future. The planning is appropriate when a patient faces difficulties in making decisions about the diagnosis and treatment. Care planning process also refers to as regular process of care, which is reorganized on a regular basis. This process is helpful for the patients to recognize the personal values as well as objectives about their health along with medical treatment (EPEC, 1999). Care planning is an important aspect to improve the overall health of a patient. Through this planning, patients are able to understand how to plan for the decision and enhancing knowledge about the disease. This planning is essential to make the plan for care of complex diseases on a regular basis (NSW Government, 2013). Care planning provides various plans in relation to care for life on a step-to-step basis. It is also helpful to enhance knowledge with regard to health value (NSW, n.d.). The provided case scenario is based on a 60 years old patient, Mrs. Violet Stanford. Recently, she has been detected with lung cancer. She is having a tumour in the right middle lobe and is admitted for the problem in the right middle lung. She has two children and her husband works in Network Rail. She has the habit of smoking since 40 years. She has been suffering from chronic obstructive pulmonary disease (COPD) for the last 10 years. During winter season, she suffers from chest infection. She also has osteoarthritis in her knees and hips. From the above scenario, it can be analysed that Mrs. Violet is having several diseases, which are complex. Based on these complexities, she is required to have chemotherapy post surgery for the treatment of her lung disease. After the surgery, she has been prescribed with different medicines and observation requirements. Accordingly, the case of Mrs. Violet is an appropriate one for obtaining adequate knowledge relating to nursing practices. Airway management referred to as medical process, which enables an open airway between the lung of patient and outside. This process is essential for Mrs. Violet, as it helps in airway suction and it is used for minimizing the risk of airways obstruction (Queensland Government, 2013). Post-operative pain management is a vital part of modern practice of surgery. This management is important for Mrs. Violet to reduce chest pains and for quick recovery as well as prompt release from hospital (WEBD, n.d.). Chest drain management is essential for Mrs. Violet to recognize the safe insertion and removing the chest drain. It also referred to as chest tube (NHS, n.d.). Airway Management Rationale for Choosing Airway Management as the Top Priority for Mrs. Violet Airway management is an important medical procedure for better aspiration of patients in and after a surgery. Airway management has been used for Mrs. Violet for certain advantages based on her health priority. The medical procedure would aid the patient for exchange of oxygen and carbon dioxide during respiration. Airway management would also aid in minimising additional health risks arising from the respiratory issue. In addition, airway management is effective during treatment for better interventions during surgery and mechanical ventilation. Based on the aforementioned advantages, airway management is in the first priority for Mrs. Violet (Ball & et. al. 2012). Importance of Maintaining a Good Airway Post-Operatively Effective airway is essential for the patients who have lung cancer problem. This management helps them for respiration. The basic airway tool and technique of airway management is Bag Mask Ventilation (BMG). Airway management requires appropriate techniques as well as tight mask, as without appropriate procedures BMG fails. This type of ventilation is required for delivering oxygen and removing carbon dioxide. The importance of maintaining good airway is the proper use of airway to save the life of patients (Airways, 2009). Possible Complications That Might Occur For Mrs. Violet Several possible complications may occur for Mrs. Violet, as she has lung cancer and she had lobectomy as well as suffer from chronic obstructive pulmonary disease. These diseases may raise certain possible difficulties for the patient at the time of surgery. Another possible complication during the surgery may be that these diseases may obstruct the surgery and increases chance of life risk. Other difficulty may be patient can suffer some additional diseases along with the major disease (NCBI, 2013). The Importance of ABCDE Assessment When Doing Vital Sign Observations after the Surgery, and the Need to Have an Accurate Assessment ABCDE assessment implies Airway, Breathing, Circulation, Disability and Exposure assessment. This type of assessment is important for vital sign observation after the completion of surgery. Vital sign observation should be related to proper communication between ‘nursing’, ‘medical’ as well as ‘health professional staff.’ The objective of this observation is to have a proper review of medical requirements. The objectives of ABCDE assessment are to provide a best treatment to safe life. This assessment is important for breaking the difficult situation of clinic into controllable parts. Another goal is to develop a consciousness about the situation among the all treatment providers. Other objective of this assessment is to purchase additional period for the treatment. This assessment is important for all patients. In this respect, the assessment will be effective in the case of Mrs. Violet, as it will provide adequate information in relation to her vital sign observation after the surgery. Subsequently, information relating to her health condition after the surgery can be observed in a continuous manner (Thim & et. al. 2012). The Interventions Available For Mrs. Violet to Make Her Feel More Comfortable At this time, family support is more important for Mrs. Violet to make her feel comfortable. The support of the family members is the strong key for the patient. Home care mediations are essential aspects to improve the health diseases of Mrs. Violet and avoid future complications. Emotional support is a key consideration to make the patient feel comfortable. In addition, she is prescribed with inhalers and medicines for her quick recovery after the surgery (Palliative care, 2004). Possible Outcome/ Goal The possible goal or outcome of airway management is to identify the principles of airway management and definitively manage the breathing problem of the patient. Another objective of airway management is to recognize the system as well as the tool of breathing. The objective of airway management is to provide ventilation support for breathing. In this respect, the patient with the provision of this medical procedure can be provided with the support of aspiration. In addition, the assessment and the medical procedure would assist in better examination of health condition of the patient and manage respiration (Jones & Bartlett Learning, 2013). Post-Operative Pain Management Rationale for Choosing Pain Management as the Second Priority Post-operative pain management is a vital part of modern practice of surgery. This management is useful not only for minimizing the suffering problem of the patients, but also to decrease morbidity and are availed with the facility for quick recovery as well as early discharge from hospital. This type of management has several effective objectives such as it minimizes the injury and enhances the quality of life for the patients. This management is essential for the quick recovery of the patients, so that they discharged from medical facilities as soon as possible and it reduces cost due to early release from the hospital. For the above advantages, post-operative pain management is in the second priority for Mrs. Violet, as post-operative pain management would aid in minimising pain (WEBD, n.d.). Why Do You Think Violet Needs a Good Pain Management Post Operatively Mrs. Violet needs a good post-operative pain management to be relieved from pain and for quick recovery. According to the scenario, Mrs. Violet has been suffering from several major diseases for the last few years along with chest pain. Post-operative pain management is the essential key to provide her relief from the health issue related to chest pain. This management has the available methods for quick pain treatment. This type of management helps the patient by providing complete information as well as knowledge about the post-operative pain and pain treatment, which is important for quick recovery (WEBD, n.d.). Complications When Pain Management is Poor Post-Operatively Possible complications as well as difficulty of poor post-operative pain management may be the result of the changes in surgery that may increase the injury as well as the treatment cost. It will also increase the pain and the disease as well as it will take long time for recovery of the patient. Post-operative pain is a problem, which has the serious effects on the outcome as well as cost of healthcare of the patient. The difficulty of poor post-operative management is that it can decrease the quality of life of the patient (Anaesth, 2011). Interventions available in Post-Operative Pain Management Post-operative pain management should provide the attention on the combination of pharmacological management and relief measures for delivering maximum pain relief to each patient. Several interventions, which are available in post-operative pain management are ‘pre-operative pain assessment’, ‘pre-emptive analgesia’, ‘multi modal analgesia’, ‘open surgery’ and ‘post-operative analgesia’, ‘Pre-operative problems’, ‘endoscopic procedure’ and ‘systematic analgesia methods’ among others (AHRQ, n.d.). Prescribed Pain Management Medications Prescribed For Mrs. Violet in the Scenario The pain management mediation prescribed for Mrs. Violet is paracetamol 1g for 4-6 on hourly basis. Salmeterol 100mcg is important 12 hour through inhaler. Mrs. Violet has to take beclametasone diproprionate 400mcg 12 hour through inhaler. Tiotropium 18mcg is essential for Mrs. Violet daily one time through inhaler. Mrs. Violet also needs Carbocisteine 500 mg 8 on hourly basis. These entire medications have their own importance for the recovery the life of the patients. The Importance of Pain Assessment Using a Structured Approach and How It Will Help Manage Patient’s Pain Pain assessment approach or method is essential for assessing the pain and manage the pain of patients. Assessment is an essential component of pain management. This assessment is useful for the patient, as it has the structure as well as cognitive method for selecting a best way for the recovery of patient’s health. This assessment is important for the patient to collect knowledge about pain. In this respect, with the assistance of structured approach, the patient will be facilitated in having relief from pain (Neurology, 2010). Possible Outcome / Goal The possible outcome or goal of post-operative pain management is to enhance the quality of life and reduce pain of the patient. Another objective is to recover the life of the patient quickly by providing best treatment and release them from the hospital as soon as possible. This management is important for the patient suffering from chest pain, as it provides accurate information about pain treatment (WEBD, n.d.). Chest Drain Management Rationale for choosing this (relate to the scenario as her surgical site is currently oozing and there is small of blood in the drain bottle) Chest drain management is also referred to as under water sealed drain introduced to permit draining of air as well as blood. It also allows in managing the functioning of lungs and renovation of undesirable pressure that occurs in the thoracic cavity. This management is essential to avoid backflow of air and maintain the function of breathing. It is useful, as it enhances the care of patients who are adult with the help of chest drain. It also provides proper drainage system for better care of the patient. This type of management is important for Mrs. Violet in order to ensure haemodynamic stability as well as respiratory function (NHS, n.d.). Outline Some Possible Complications That She Have or Will Have with This Kind of Procedure and the Effect to the Patient The possible complications that may occur due to chest drain management are bleeding as well as pneumothorax. Another complication is of infection at the site of insertion. These complications are the major problem for the patient. The patient with this care need may face complication in terms of elongated healthcare requirement, which may harm the internal structure of the body such as liver and lung. There can be injury in the intercostal nerve of the patient for inappropriate management (Chest drain, 2014). What Are the Interventions and How Will You Avoid These from Happening and How Will You Assess the Patient The possible intervention to avoid the aforementioned complications is the chest tube, which decreases the danger of accumulation of blood. There are two types of chest tube to drain blood. This management assesses the patients to enhance their healthcare by delivering proper drainage system. Through the appropriate drainage system and chest tube, they can drain the air as well as blood to avoid the complications that may arise in the patients. To avoid the complications of this management, the patient should be aware of the complete information about the treatment of chest drain (Chest drain, 2014). Why is it Important to Look after and Manage the Surgical Site Appropriately In chest drain management, it is important to look after and manage the surgical site appropriately. This management provides accurate information about chest drain and chest drain treatment. This type of management is essential for the patient, as it allows the drain of blood through the tubes. It also improves care and treatment offered to the patient as well as expands the lung. This type of management is essential at the time of surgery of the patient to avoid the complications such as infection and injury of internal parts of body (Chest drain, 2014). Possible Outcome (Goal) The goal of chest drain management is to facilitate the drainage of air and blood from the thoracic cavity. Another goal is to develop restore and expand the lung for minimising respiratory issue. This management is important for the patient, as it avoid disconnection in the backflow of air as well as blood. In this respect, chest drain management assists in the maintenance of respiratory function as well as haemodynamic stability (Chest drain, 2014). The Ways to Support Mrs. Violet’s Family The way to support the family members of Mrs. Violet at this point of time when they are anxious about her admission and prognosis is to provide them a belief and strong view that she will be fine as soon as possible. Emotional support can be key aspects to support her family during this time, because it is very crucial time for the family members of Mrs. Violet. Mrs. Violet is suffering from various diseases, which are considered as major diseases. By providing information related to her health, it is possible to support her family at this situation. By informing the importance of prescribed medication, it can be possible to support her family. Her family members are very close to her and they all love her very much. Therefore, the family members can be tensed about the health problem of Mrs. Violet. Other way to support them can be by helping them in their activities and tell them to pray for the recovery of Mrs. Violet. By communicating to the family about various advances medical methods used to recover the life of Mrs. Violet, is also an important way for supporting the family about the treatment and care offered. Conclusions From the above discussion, it can be stated that care planning is a process of medical care as well health care for the future. This process delivers a proper planning for health care to the patient in terms of health recovery. This process is helpful for the recovery of the patient. From the above scenario, it can observe that 60 years old woman suffering from lung cancer. Along with the lung cancer, she has many other diseases that include chest pain and osteoarthritis. She has been prescribed with several medicines for her major diseases. Accordingly, based on her health condition and surgery, there are three types of management that include airway management, post-operative pain and chest drain management are offered for the recovery of Mrs. Violet. These three types of management have their own advantages through which health condition of Mrs. Violet could be recovered and improved. Airway management is the top priority, post-operative pain management is in the second priority and chest drain management is in the third priority for Mrs. Violet for relieving her from pain and quick recovery from injury. From the different care needs offered, it can be concluded that airway management is helpful for providing better aspiration support. Post-operative management is essential for the quick recovery from the pain and early release from the clinic. Chest drain management is important for draining blood as well as air and improve the healthcare of adult patient. References AHRQ, No Date. Guideline Summary. National Guideline Caring House. [Online] Available at: http://www.guideline.gov/content.aspx?id=23897 [Accessed December 21, 2014]. Airways, 2009. Manual of Adult Airway Management. University of Florida, pp. 1-22. Anaesth, J. 2011. Emerging Concepts in Post-Operative Pain Management. Indian Journal of Anaesthesia, Vol. 55, No. 2, pp. 101-103. Ball, R. D. & et. al. 2012. Surgical Critical Care and Trauma Part 2: Airway Management in Trauma and Critical Care. Universities of Toronto Libraries, pp. 1-18. Chest drain, 2014. Chest Drains – CHW. Practice Guideline, pp.1-25. EPEC, 1999. Advance Care Planning. Education for Physicians on End of life care, pp. 1-21. Jones & Bartlett Learning, 2013. Airway Management. LLC, an Ascend Learning Company, pp. 1-33. NCBI, 2013. Video-Assisted Thoracoscopic Lobectomy for Non-Small Cell Lung Cancer in Patients with Severe Chronic Obstructive Pulmonary Disease. Journal of Thoracic Disease. [Online] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771612/ [Accessed December 20, 2014]. Neurology, 2010. Recognition and Management of Pain in Dementia. Midlife and Beyond, pp. 499-507. NHS, No Date. Guidelines for the Insertion and Management of Chest Drains. Doncaster and Bassetlaw Hospitals, pp.-14. NSW Government, 2013. Advance Planning for Quality Care at End of Life. NSW Ministry of Health, pp. 1-43. NSW, No Date. Standards for Competence for Registered Nurses. Nursing & Midwifery Council, pp. 1-21. Palliative care, 2004. Symptom Management and End-Of-Life Care. Integrated Management of Adolescent and Adult Illness, pp. 5-50. Queensland Government, 2013. Airway Management. Queensland Ambulance Service, pp. 1-21. Thim, T. & et. al., 2012. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International Journal of General Medicine, pp. 117-121. WEBD, No Date. Postoperative Pain Management-Good Clinical Practice. General recommendations and principles for successful pain management, pp. 1-57. Read More