Nursing Interventions in Care Mrs. Blackwell - Case Study Example

Introduction In Assignment 1 on care plan 1, I came up with various recommended nursing diagnoses with their respective goals in relation to Mrs. Blackwell’s condition. The nursing diagnoses dealt with include; Diagnosis 1-Risk of impaired skin integrity related immobility as evidenced by the previous fall and recent surgery. The goal for this nursing diagnosis was to help Mrs. Blackwell to adjust herself and enable her to cope well at home. Diagnosis 2- Potential risk of altered nutrition related to self-care deficit in feeding as evidenced by her difficulty in getting out of house to shop. The goal for the diagnosis was to ensure Mrs. Blackwell is admitted in a rehab so as to monitor her dietary intake. Diagnosis 3- Polypharmacy use and risk of associative symptoms. The goal for the diagnosis as to ensure Mrs. Blackwell received recommended drugs at a recommended dose. Therefore the intention of care plan B is to come up with appropriate nursing interventions that can be offered to Mrs. Blackwell to help improve her condition. The essay will outline the appropriate care Mrs. Blackwell will receive, identify appropriate nursing interventions to achieve the goals developed in Assessment 1 and finally discuss how nursing attitudes can affect the care an older person may receive. Nursing intervention Interventions to be made by the nurse in charge can be based on the physician’s order such as medication orders or activity orders. They can also be made basing on the standard nursing practices such as repositioning for comfort. The interventions made should be documented daily to help in monitoring the condition and progress of the patient. Nursing intervention 1 In relation to reduced mobility; in assessing a patient’s risk for complications of immobility, the nurse should be aware that there are several reasons for a person becoming immobile. 1. In case Mrs. Blackwell is willing to walk the nurse can help her walk. This can be done by assisting the transfer of the patient when it’s needed. Constant supervision of the patient when visiting the toilet should be undertaken strictly. Rationale This can assist the patient increase mobility at the same time help protect the patient from becoming debilitated. Constant supervision of the patient by a nurse can help protect the patient from falling that may cause accidental injury causing physical impairment. 2. Another nursing intervention is helping the patient learn how to move around with the aid of assistive devices such as walkers, crutches or wheel chairs. The nurse should avail the correct device to be used and ensure that it’s in the right state for example ensuring that the height is correct in relation to the patient’s height. Rationale This can assist in increasing mobility at the same time ensuring that the patient remains comfortable and prevent any form of straining to prevent occurrence of physical injury. 3. Helping the patient to perform a range of motion exercises. The nurse can teach Mrs. Blackwell perform a number of exercises as recommended by the physiotherapist. Rationale This can help prevent stiff joints and maintain muscle strength hence maintaining or increasing mobility. This will prevent the eventual occurrence of adverse effects of immobility (Maas, 1989). 4. Keeping the patient's skin moisturized, clean and dry as well as turning the patient on a schedule may prevent sores from developing 5. The nurse in charge should also try to keep the patient safe, ensure that her bed is placed at a low position and side rails on the bed should be raised up. If possible bed stabilizers, a specific furniture alteration used in the hospital setting can be used to prevent the bed from rolling. Rationale This will enable Mrs. Blackwell have ample time in case she wants to move and prevent her from straining a lot especially if the bed is placed at e higher position. Ensuring that bed side rails are raised up helps protect the patient from falling when turning. This is because falls can result in impaired mobility due to physical injury or psychological distress following the fall The use of bed stabilizers help in preventing falls as a direct result of the bed rolling or moving away from the patient getting in or out of bed (Tinetti et al, 1988). Nursing intervention 2 In relation to - Polypharmacy use and risk of associative symptoms. Polypharmacy is the taking of too many drugs than clinically recommended. This can result in a number of negative outcomes for both patients and healthcare facilities. These include negative outcomes such as adverse drug effects, hospitalizations, poor patient health, as well as economic outcomes such as increased drug cost and costs associated with increased utilization of health services. Research has shown that pharmacists and other health professionals have the potential in combating this problem through a variety of interventions such as reducing the number of medications taken, reducing the number of doses taken, increasing patient adherence, preventing adverse drug reactions (ADRs), improving patient quality of life and decreasing facility and drug costs. The following are the nursing interventions that can be carried out to help Mrs. Blackwell deal with the problem of Polypharmacy: 1. The nurse should ensure that the right and recommended drugs are given to Mrs. Blackwell. This should include the correct dose, dosage and regimen. Rationale This will significantly reduce the chance for sustaining ill-effects from taking medications, including taking them properly. 2. By employing comprehensive pharmacist interventions that include patient education and follow up, patients could become more adherent and feel empowered. Ensuring that the patient and the nurse are made aware of the risk of improper medication use. It is extremely important for the nurse in charge and patient to be aware of what medication or multiple medications are being prescribed and used. Teaching and learning about the medications and their reason for use, drug interactions, adverse side effects, interrelationships, while maximizing the benefits of taking them has become absolutely necessary (Chumney EC, Robinson LC, 2006). Rationale This helps reduce the drug burden to the patient hence preventing occurrence of increased adverse drug reactions. This can also cut down on the higher drug cost. 3. Another intervention that can be made is to ensure that the patient visits a limited number of physicians when she needs medical attention. Rationale Visiting multiple physicians or pharmacies may result in prescription of more unwarranted drugs hence causing adverse effects to Mrs. Blackwell thus endangering her health. 4. Simplifying the drug regimen, the patient may be able to understand. Studies have shown that using pharmacist interventions and education can increase a patient’s adherence with his or her medication regimen. Rationale This will help the patient understand her treatment and the importance of remembering to take their medications. Understanding why she is using her medications and how they work, can increase her involvement in her own healthcare and encourage her to learn about her condition and take charge. Nursing Intervention 3 In relation to Potential risk of altered nutrition related to self-care deficit in feeding. Proper nutrition is a vital part of the healing process. Imbalanced nutrition can lead to poor wound healing, heart disease, bone loss and other damage to the body. Recognizing unhealthful eating patterns is part of a nurse's duty. An intervention due to diagnosis of imbalanced nutrition can be given to a patient who takes in more or less than the body requires. 1. Provision of a balanced and healthy diet. The nurse in charge should ensure that while Mrs. Blackwell stays in rehab she is given food that is in the right diet as directed by the dietician. During her stay in rehab nurses can have Mrs. Blackwell keep a 3-day dietary history. Involvement of a dietician and ensuring nutrition assessment is done is necessary to assist in modifying her diet. Rationale This will ensure that Mrs. Blackwell remains in good health and does not develop indigestion that may eventually result in her developing constipation issues. Inactivity, decreased fluid intake, and lack of adequate fibre in the diet can combine to cause constipation. Activity is not an option for this patient, but encouraging a high-fibre diet and increased fluids can help prevent or relieve constipation (Taylor et al 2008). 2. Caregiver may assist her with toileting and record her bowel open and documentation. (Brown and Edward, 2006, p. 1021) Attention to and correction of the many reasons for poor nutrition and bowels function in older adults is an important nursing issue that should be adhered to by the health professionals. Determine the outcomes by recording the number of times of toileting, and the kind of stool of Mrs. Blackwell (Funnell, Koutoukidis and Lawrence 2007, p.613 Rationale This will ensure the patient has proper digestion so that she does not experience problems when passing out stool that usually occur due to poor diet. Recording the number of times the patient visits the toilet and also the type of bowel will help in determining any health problem so that further action can be taken. 3. Assisting the patient with meals if needed, providing company and encouragement while they eat by the nurse in charge. Rationale This will motivate the patient to take a required amount of food in the correct proportions as directed by the nutritionist to help avoid complications such as constipation. 4. Educating the patient about the need for proper nutrition and continuing to monitor eating patterns. The nurse can document weight changes and monitor the patient's intake. Rationale This will help Mrs. Blackwell stick on a healthy balanced diet. Monitoring eating habits will help is assessing whether the patient is at risk of imbalanced nutrition. Patient expressing loss of appetite may be at risk for eating less than body requirements, while a patient who is constantly requesting extra food over a period of several days could be at risk for taking in more than the body require. Considerations A patient's eating habits are a sensitive matter and should be approached as gently as possible. While it is important to make sure the patient is getting the right amount of nutrition, it is also important to make sure he or she feels comfortable talking to you about it. When a patient is offended, he or she may become defensive and feel judged which makes it difficult to keep an open dialogue and provide education. State the facts, explain the need for good eating habits, but do it with tact and kindness (Taylor et al 2008). How nursing attitudes can affect the care an older person may receive. The kind of attitude portrayed by nurses towards the elderly can either be negative or positive depending of various factors. A positive attitude towards the patient by the nurse indicates that the patient is receiving good quality care which in turn will result in a positive response. A negative attitude on the other hand indicates that the patient is receiving poor quality care which may in turn the patient’s health negatively to the Nurses feel ill at ease in the presence of older people and find them different, complaining incapable of adjusting to situations. This can be due to prolonged exposure to ill and infirm older patients leading to emotional rejection and stereotyping rather than individualization. This emotional rejection has significant repercussions on the quality of care older patients may receive in an acute care setting, particularly from nurses who prefer not to work with patients 65 years and older. This behavior can in the end result in the nurses neglecting them hence negatively affecting their health. These negative attitudes might have a significant impact on the quality of care their older patients receive. For example, when older patients are perceived as difficult and complaining then their requests to nurses may not be taken seriously impacting on the care they receive, thus resulting length of hospitalization and prolonged recovery. The independence of older patients is severely threatened by nurses’ negative stereotyping and ageist attitudes. This puts them at risk maintaining independence, when making decisions about their care and place of residence after being discharged and the use of restraints and their potentially harmful side-effects. Nurses have significant knowledge deficits related to ageing which considerably influence the quality of care older patients receive (Hope, 1994). Implications for care are vast and include little consideration of, for example, older patients’ reduced sight, hearing and touch, when planning and performing nursing care (knowledge); increased probability of developing pulmonary complications (knowledge); high probability of being referred for institutional care post discharge (attitude); limited health education (attitude) and social isolation (attitude). Nurses preferring to care for older patients gravitate to community and elderly care areas rather than acute care settings. Therefore, nurses with less positive and more negative attitudes toward older people and a lack of interest in this group of patients are caring for older patients in the acute care setting and such a situation may jeopardize the health care of older patients (Hope, 1994). A care plan for the nursing intervention "impaired physical mobility" focuses on providing a safe environment for patients; maintaining whatever ability they have in terms of being able to move; and preventing further deterioration of the patient's functional abilities. To meet these goals, certain nursing interventions are included in the care plan and then implemented. The care plan for the nursing intervention on the patient at risk of Polypharmacy is geared at preventing pill burden that can help deter the occurrence of adverse effects on the patient. Care plan for the nursing intervention with potential risk of altered nutrition related to self-care deficit in feeding is geared at ensuring that a proper diet is given as recommended by the nutritionist. Patients should also have scheduled toileting times with adjustments in the schedule based on the patient’s voiding patterns. Conclusion The elderly population, which often suffers from multiple chronic diseases requiring multiple medications, continues to increase. These patients are much more likely to experience polypharmacy and its negative consequences, especially adverse drug reactions (ADRs). ADRs are one of the most troubling issues surrounding medication use in the elderly, as this patient population is more likely to have poor outcomes than others. The kind of care given to the patient can greatly influence the response of the patient to treatment and eventually the recovery period. Therefore, when taking care of patients especially the elderly, the nurses should intervene positively and act professionally. In addition they should ensure that any intervention made towards the patient is appropriate and is done with the sole aim of improving the patient’s health. Nurses should also treat the elderly as a special group of people who require special attention due to their increased needs. Finally the nature and importance of nurses’ awareness and consideration of the important factors is the key to positive impact on the elderly patients. Therefore, increased awareness should be created to ensure that nurses receive the necessary knowledge in relation to the care kind of care the elderly patients should be given. This can be done through continued medical education among health professionals. References Adam, M.H., et.al. (2001). Levels of prevention: restructuring a curriculum to meet future health Care needs. Nurse Educator, 26 (1): 6-8. Australian Nursing and Midwifery Council Inc. (2006). Competency standards for the registered Nurse (4th Ed.). Retrieved 3rd October, 2011 from http://www.anmc.org.au/docs/competency_standards_RN.pdf Blackwell Publishing Ltd. (2003). Journal of Clinical Nursing. (12) pp.697–706. Chumney E. C and Robinson L. C. (2006). The effects of pharmacist interventions on patients With Polypharmacy. Pharmacy pp. 103-109. Brown, D and Edward, H. 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