Implement and Evaluate a Plan of Nursing Care - Case Study Example

Running Header: implementing and evaluating a nursing care plan Client inserts name Client inserts tutor’s name Name of institution Course title Date of submission 1. How can you monitor and evaluate the client during care? Discuss based on the meads model care plan addressing every aspects including meeting emergency situations. Revathy is diagnosed with renal disease which is managed pharmacologically and at the same time she is obese and has walking problems. The patient needs respiration checks, blood sugar management, blood pressure checks, check of arterial gas and hourly temperature monitoring. Moreover, Revathy needs continuous cardiac rhythm monitoring as well as occasional arterial blood pressure monitoring (Olsson, 2002). The patient needs continuous central venous pressure monitoring and monitoring of the central nervous system since she ambulates with a 4WF with one person’s assistance. The care giver should be always by her side since she needs assistance in performing ADLs. She is on oxygen 3L via nasal prongs due to breathing difficulty hence the need for continuous respiratory checks. Strict fluid balance monitoring is important since the patient maintains a saturation of 92-95% with Oxygen. She is a falls risk person hence needs somebody around all the time to avoid any injuries. Due to the renal condition, hourly urine output checks are also necessary (Astredt & Isola, 2001). Woodward (2004, argues that the medical care plan should involve the administration of inotropes, administration of oxygen, initiation of intra-aortic balloon pump counter pulsation if it is not contraindicated, active warming, administration of diuretics and r GTN may also be applied. Since malnutrition is possible with renal disease patients, it is prudent to monitor trends in target weight and also ensure constant evaluation of recent intake. This can be the best tools to alert the clinician to changes in nutrition status. It is also good to avoid unnecessary diet restrictions and address underlying conditions that impair oral intake. The medical care plan should provide nutrition support when oral intake is inadequate to prevent malnutrition (Olsson, 2002). According to Astredt & Isola (2001), the type of care suitable for the patient at hand should be patient centered, hence defining her needs as the main factor that shapes health care delivery processes and practices as well as supportive services should be put into consideration. The care will thus focus on each an individual’s needs rather than tasks performed routinely, and professional boundaries. The patient’s own unique illness experience context is regarded as important. The care should be provided collaboratively with the patient and family members this is because patient case given is complicated and needs everybody to take responsibility in medical, social and psychological care. Communication is one of the most important factor in obtaining patient-focused care (Woodward, 2004). Since Revathy is elderly and has difficulties in moving around, the patient is bound to succumb to psychological traumas for fear of death. The health care plan should contain positive environment distracters, such as nature and art, which have positive effects on psychological heath due to their recreational value as argued by Yura & Walsh (1988). Therefore, the supportive health care design will support coping with illness by fostering control and privacy, promoting social support, promote stress reduction and provide easy access to nature and other distractions which will impact a patient’s health positive. The patients should have an upper hand in making decisions regarding their own care health care process. The health care design should support and facilitate access to information such as the patient's records, and staff. Furthermore, all supportive design should provide low noise level; visible areas for privacy and easily found movement routes. Patients should have control over light, sound and social contact (Woodward, 2004). 1. How can you evaluate the nursing care provided by you to Revathy? Patient care and care planning interventions methods require critical decision making since they are part of a complex process. The process need to be geared towards safety, continuity and patient satisfaction with the nature and level of care provided. The model presented above gives much insight into the patient condition and looks into the problems systematically and comprehensively with the aim of generating new ideas for improvement. The nursing care model used is efficient since it organizes knowledge and creates theoretical framework that gives room for further improvement of the specific health care process (Yura & Walsh, 1988). The medical care plan offered involves a combination of health care team members which includes nurses who coordinate the process. A critical point in health care planning is decision-making process. This process involves assessment of the need and diagnosis of patient health which influences the decisions made about actions for care intervention. It is unavoidable to involve variables such as health. It is by necessity hard to give equal importance to many existing health care variables and the relationships between these variables. The patient’s perceived health for example, is a subjective variable but is still measurable although not in the same way as a variable such as the number of patients admitted on a daily basis. Variables such as quality of the care plan or patient health can be quantified anyway by setting them against a given index of some kind, such as 0-100, and defining what the magnitudes stand for. This is a structured care plan which is taken to be the best in fulfilling the quality of the structured care plan. However, it is not very creative to use the concept of intangible variables for all the variables that are unknown to the system dynamics community. The variables of health, quality of life and patient satisfaction are well defined and have been measured for a long time. Consequently, they are possible to quantify in a model (Yura & Walsh, 1988). On the other hand, health care decisions cannot be purely based on clinical experiences and ideas about it. Evidence-based health care can be described both as a process of gathering evidence about care and as an attitude to knowledge about health. The goal is to always have the best evidence about a given patient which involves social, psychological and health care which will help in making the right decision. This is what the plan applied on Revathy is seeking to achieve. All in all, medical health care plans for all patients should be scrutinized extensively against a logical, evidence-based model in order to improve practice as best as possible. The nursing care offered to Revathy is comprehensive since it takes into consideration the fact that adequate care planning implies not only shared decisions between the patient and health care professionals but also a deep understanding of the patient's health needs. It is a precise that health care is more about prevention of complications, symptom management, and long-term relationships, rather than cure which may help the patient recover or rather enjoy content care (Struthers, 1999). 2. Discuss a suitable discharge plan for Revathy. According to Williamson (2004), discharge planning is a multidisciplinary process. In Ideal cases, the admitting nurse who first meets the patient should start the assessment and identify what Revathy needs in the aged care facility. This plan is added to by utilization review nurse, staff nurses, the therapists, the physician, and the social worker-virtually every discipline. However, the discharge planner coordinates all the activities to the patient’s benefit. This is to make ensure that all efforts possible have been directed towards best possible continuity of patients care in the aged care facility. Revathy may be discharged from the hospital in 2 days to an aged care facility and this requires a needs assessment process because the facility will be a new place for the patient. During the assessment process, various professionals should keenly focus on their care responsibilities for the individual patient. During that process, comprehensive picture of the patient's care needs will be obtained in regards to the aged care facility. The nurse assessment the patient begins with a making medical record review, interviewing the patient, and involvement family. Only after these have been achieved can concerted efforts be made to properly help the patient with post hospital care. Discharge planning is very important for Revathy as it entails processes which the patient is assisted to develop a care plan for ongoing maintenance and improvement of health care, even after she may be discharged from the finely tuned care hospital. Discharge planning, sometimes referred to as continuity of care, in the case offered seek out to provide services that will enable the patient to be independent (Yura & Walsh, 1988). The medical record is a vital tool in assessing the patient. The physical history examination, emergency room report, physician progress notes, nurses' admission assessment report, notes from physical therapy report, laboratory and radiology reports, respiratory therapy, the dietician report and the pharmacist should be obtained. It is easy to understand the patient's abilities and disabilities and thus plan for her continuity. The discharge plan should involve informing the patient about her next physician's appointment and explaining medication schedules to her. These two items are immensely important to the patient's continued good health in the aged care facility. The discharge plan focuses on liaison with home health care since Revathy needs much attention and social support in the aged care facility (Williamson, 2004). Revathy should have been informed earlier enough that she is leaving hospital as well as other family members concerned. This may reduce possibility of anxiety or the feeling that she was discharged prematurely. Medical records should then be reviewed and sanctions be given for the patient to root out any doubts of quick discharge and to help medical care givers in the aged care facility to follow up on her health (Struthers, 1999). The discharge plan should involve diet guidelines for the care givers in the aged care facility. Crutch training and any other therapy requirements should also be included. Since the patient does not know much English, a communication plan is necessary to help the caregivers understand the patient’s language need. It is important to consider the availability of necessary equipment required by Revathy in the aged care facility and if the room provided is enough for all the care needs to be accomplished. Most importantly, it is good to know if the patient the has significant others who will help with post-hospital care or the aged care facility is adequate in regards to satisfaction of patient needs (Williamson, 2004). According to Struthers (1999), adequate preparation for the transfer can often help prevent after discharge problems. When the family and patient all agree that a nursing home is necessary, problems are less likely to arise. Therefore, the discharge plan should be acceptable to all stakeholders to avoid any post discharge problems. References Astredt, K. & Isola, A. (2001). Journal of Advanced Nursing. Vol 35, No.3, PP452-458 Olsson, H. (2002). Journal of Nursing Management Vol.10. pp 21-26. Struthers, J. (1999). Journal of Advanced Nursing. Vol.29, No.5, pp 1197-1204. Woodward, V. (2004) .Mead Ward Nursing Care Plan-based on the Mead Model for Nursing Part II: International Care Nursing: 1987: Vol.3, Volume 3. Williamson, G. (2004).Mead Ward Nursing Care Plan - Based on the Mead Model for Nursing – Part 11: International Care Nursing: 1987:Vol.3, Volume 3. Yura, H. & Walsh, M. (1988). The nursing process. Assessing, planning, implementation and Evaluation. 5th ed. 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